APPOINTMENT AS COUNSEL/ REPRESENTATIVE

with Authority to receive Certificate of Canvass/

Certificate of Canvass and Proclamation with
Statement of Votes/Other Accountable Forms

In accordance with Section 20 of the COMELEC Resolution No. 9648, I hereby

appoint:

ATTY.________________________________________________

as my Legal Counsel with special responsibility to provide and take appropriate legal
and remedial steps, measures and procedures to promote and safeguard my rights
and interest as one of the candidates for_________________________. S/he is also
authorized to receive the Certificate of Canvass (COC), Certificate of Canvass and
Proclamation (COCP) and Statements of Votes (SOV) by the Municipality of
Rodriguez, Rizal.

____May 2013, Municipality of Rodriguez. Rizal, Philippines.

_____________________
(Name and signature of the local candidate)

CONFORME:

Signature over printed name of counsel

 APPOINTMENT OF LEGAL COUNSEL

I, _________________, by virtue of the powers and authority vested in me

by the Constitution and By-Laws of the AKSYON Party as __________________,
hereby appoint

ATTY._______________________

to act and appear as Counsel for the Party in connection with the May 13, 2013
elections with authority to receive all accountable forms, including Election
Returns and Certificate of Canvass intended for AKSYON as one of the
recognized local political party in the Municipality of Rodriguez by virtue of
COMELEC Resolution No.___________________.

_____________________________