SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, ____________________ of legal age, married, Filipino and a resident of

_________________________________ do hereby NAME, PLACE and APPOINT,
________________________of legal age, single, and a resident of Miravite St., Cabatuan, Iloilo, to be
my true and lawful attorney in fact, in my name, place and stead to do the following acts and things to wit:

To transact, process, follow-up and received my Retirement Benefits and other benefits with the
Government Service Insurance System (GSIS);

To make, sign and execute whatever documents and perform other acts necessary for the
accomplishment of the aforementioned purpose;

To receive the check due me from the Government Service Insurance System (GSIS);

HEREBY GIVING AND GRANTING, my said attorney-in-fact full power and authority whatsoever
requisite and or necessary or proper to be done in or about the premises as fully to all intents and
purposes as I might or could lawfully do if personally present with power and substitution or revocation and
hereby ratifying and confirming all that my said attorney-in-fact shall do or cause to be done under and by
virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________2019, Philippines.

____________________________
(Affiant)
Passport No. _________________
With conformity:

________________________
Attorney-in-Fact
PRC I.D. No. _____________

SIGNED IN THE PRESENCE OF:

_________________________ and _________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

__________________ ) S.S
X- - - - - - - - - - - - - X
BEFORE ME, in the Philippines, this ____________2019, affiant personally appeared before with
her valid identification, known to me to be the same person who executed the foregoing instrument and he
acknowledged that the same is her true, free and voluntary act and deed.

WITNESS MY HAND AND SEAL on the day, place and year first above written.

Doc. No. ________;

Page No. ________;
Book No.________;
Series of 2019.