SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, ___________, of legal age, Filipino,_____ and a resident of ________, have named constituted and
appointed, and by these presents, do hereby name, constitute and appoint my_____________, likewise of legal age,
Filipino, married and also a resident of _____________to be my true and lawful Attorney/s-in-fact, for me and in my
place and stead to do and perform the following acts and things, to wit:

1. To transact, process, follow-up and apply for and on my behalf a new ATM Card from any authorized
representative of__________________;

2. To cause and make over the counter withdrawal of my pension at____________;

3. To transact and deal with the___________, branch for the processing and/or activation of my ATM
Card;

4. To claim and receive my ATM card from any authorized representative of ____________;

5. To receive and sign any and all document inherent to the foregoing authority.

HEREBY GIVING AND GRANTING unto my said attorney/s-in-fact full power and authority to do and perform all
and every act requisite or necessary to carry into effect the foregoing authority as fully to all intents and purposes as I
might or could lawfully do if personally present, with full power and hereby ratifying and confirming all that my said
attorney-in-fact or her substitute shall lawfully do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, we have hereunto set our hands this __ day of ______ at __________________,
Philippines.

Principal
Conforme:

Attorney-in-fact

SIGNED IN THE PRESENCE OF:

_________________________ __________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

______________ )
X----------------------X

BEFORE ME, this ___ day of ______ at _______________, personally appeared the above named persons who
are known to me and to me known to be the same person who executed the foregoing instrument and they
acknowledge to me that the same is their free act and voluntary deed.

IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal on the day, year and place above written.

Doc. No.
Page No. Notary Public
Book No.
Series of 2018