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SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _____________________, Filipino, of legal age, with residence


at _________________________________, do hereby
_________________________________ Filipinos, of legal ages,
married with address at 03A Opal St., Pines City Royale Subd., San Roque,
Antipolo City, to be my true and lawful attorney-in-fact to act, for and in
my stead, to do and perform the following acts deeds and things, to wit:

1. To use and safekeep my vehicle described as follows:


MODEL/MAKE: 2023 TOYOTA AVANZA
MOTOR NO.: _________________
SERIAL/CHASSIS NO.: _________________
PLATE NO. : _____________________
CONDUCTION NO.: ______________________

2. To sign, execute and receive the necessary documents in relation to


my application for the Certificate of Public Convenience, Provisional
Authority and other documents issued by the Land Transportation
and Franchising Regulatory Board, Land Transportation Office, and
any Transport Network Company;

3. To do such any other act or thing that may be required necessary or


incidental to carry out effectively any and all of the purposes for
which this authority is hereby given, except to sell, dispose, or
transfer the abovementioned vehicle;

HEREBY GIVING AND GRANTING unto my said attorney-in-fact full


power and authority to do and preform any and every act, thing
whatsoever requisite and necessary to be done in and about the
premises, as fully to all intents and purposes as I might or could
lawfully do if personally present and hereby ratifying and confirming all
that my said attorney-in-fact shall lawfully do or cause to be done by
virtue of these presents.

IN WITNESS WHEREOF, I have hereto affixed my signature this


_______ day of _________________, 2023 at Antipolo City.
________________________
PRINCIPAL
______________________
ATTORNEY-IN-FACT

SIGNED IN THE PRESENCE OF:

_____________________ _____________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)


CITY OF ANTIPOLO )S.S.
x--------------------------------------x

BEFORE ME, a Notary Public for and in the City of Antipolo


this ______ day of _______________, at Antipolo City, Philippines,
personally appeared ______________________ with Driver’s
License with ID No. _________________ issued on December 21,
2018 at Antipolo City with expiration date of January 12, 2024, known
to me to be the same person who executed the foregoing instrument, and
acknowledged to me that the same is their own free and voluntary act.

This instrument refers to a “Special Power of Attorney” consisting of


two (2) pages including this page where the acknowledgment is written
and has been signed by the party hereof, and their instrumental witnesses,
if any, on each and every page.

WITNESS MY HAND AND SEAL.

NOTARY PUBLIC

Doc. No. _____________;


Page No. _____________;
Book No. _____________;
Series of 2023.

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