SPECIAL POWER OF ATTORNEY

I, of legal age, Filipino, with residential address at, hereby name, appoint and constitute:

, of legal age, Filipino, with residential address at

as my lawful Attorney-in-Fact, for my and in my name, place and stead, perform the following
acts, with any of the following acts constituting a valid act by me if executed by the foregoing
person named as Attorney-in-Fact:

1. To represent and transact with national and local governments, their departments,
offices, bureaus and agencies, financial and banking institutions, and other private
institutions, partnerships, and entities, in order to execute and effectuate all the required
documents in relation to any of my claim from the Social Security System (SSS), Home
Development Mutual Fund (HDMF or Pag-IBIG), Philippine Health Insurance
Corporation (PhilHealth), and/or any other government agency;

2. To agree to, receive, and acknowledge receipt of, any proceed or payment, from any of
the above specified government agencies;

3. To exercise all powers necessary or incidental to the powers above specified for the
purpose of effecting and effectively performing the same, and to hereby unconditionally
ratify, consent to, and confirm all the acts which the Attorney-in-Fact, have, shall, or will
perform in relation to the authority granted in this Special Power of Attorney.

HEREBY GIVING AND GRANTING unto said Attorney-in-Fact full power and authority to
do and perform every act and thing whatsoever requisite and necessary to be, done in and
about the premises, and as fully to all intents and purposes as I might or could do if personally
present and acting in person, ratifying and confirming all that the Attorney-in-Fact has done,
shall lawfully do or cause to be done under and by virtue of these presents.