SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

 
I, ___________, of legal age, Filipino, and with address at _______________________, after
being sworn in accordance with law, hereby appoint __________ to be my true and lawful
attorney-in-fact, to act in, manage and conduct my affairs relative to my application for
_____________ and for that purpose, in my name, place and stead, claim ______ and execute
any and all acts related to the foregoing with __________

GIVING AND GRANTING unto the said attorney-in-fact full power and authority, as may
be requisite and proper in carrying into full and legal effect any and all things reasonably
necessary and proper in the premises above-mentioned as fully to all intents and purposes as we
might or could do if personally present, and hereby ratifying and confirming all that the attorney-
in-fact shall lawfully do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ at Quezon City.

______________
Affiant

 REPUBLIC OF THE PHILIPPINES)

______________________________ )S.S.
 

SUBSCRIBED AND SWORN to before me this ____ day of _______, Affiant, who is
personally known to me, exhibited her __________________ issued on __________ and will
expire on ____________.

Doc. No.___;
Page No. ___;
Book No.___;
Series of 2019.