SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I/We, ______________________________ / ______________________________ of legal

age, single/married/separated/widower and a resident of __________________________________
__________________________________,U.K., do hereby name, constitute and appoint
_____________________________________________ resident of ________________________
_______________________________________________________________ to be my/our true
and lawful attorney, for me/us and in my/our name, place and stead, to do and perform the following
particular acts and things, namely:

HEREBY GIVING AND GRANTING unto my/our said attorney full power and authority
whatsoever requisite or necessary or proper to be done within the above-cited particular act/s as I/we
might or could lawfully do if personally present, and hereby ratifying and confirming all that my/our
said attorney shall lawfully do cause to be done under and by virtue of these presents.

IN WITNESS WHEREOF, I/we have hereunto set my hands this ___ day of _______20 ____

______________________________ ______________________________
(affiant’s signature) (affiant’s signature)
Philippine/UK Passport No. __________ Philippine/UK Passport No. __________
Date of Issue _______________ Date of Issue _______________
Place of Issue _______________ Place of Issue _______________

Signed in the presence of:____________________________ ______________________________

(signature of witnesses)

spa form revised 10/08 – Philippine Embassy, London This form is not for sale and
can be reproduced