LIMITED POWER OF ATTORNEY

BE IT ACKNOWLEDGED that I, [PRINCIPAL NAME] (principal name), with a social security

number of [#] (SSN), the “Principal”, do hereby grant a limited and specific power of attorney to
[AGENT NAME] (agent name) of [AGENT ADDRESS] (address) with a phone number of [AGENT
PHONE NUMBER] (phone) as my “Attorney-in-Fact”.

Said Attorney-in-Fact shall have full power and authority to undertake and perform only
the following acts on my behalf:

1. [POWER #1]

2. [POWER #2]

3. [POWER #3]

4. [POWER #4]

5. [POWER #5]

The authority herein shall include such incidental acts as are reasonably required to carry out and
perform the specific authorities granted herein. My Attorney-in-Fact agrees to accept this
appointment subject to its terms, and agrees to act and perform in said fiduciary capacity
consistent with my best interest, as my Attorney-in-Fact in its discretion deems advisable. This
power of attorney is effective upon execution.

This power of attorney may be revoked by any of the following:

(Initial and Check All Applicable Box/es)

[INITIALS] - By the Principal at any time by signing a Revocation.

[INITIALS] - When the act(s) designated above have been completed.

[INITIALS] - On [MM/DD/YYYY].

This power of attorney form shall automatically be revoked upon my death or

incapacitation, provided any person relying on this power of attorney shall have full rights to
accept and reply upon the authority of my Attorney-in-Fact until in receipt of actual notice of
revocation.
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State Law. This Power of Attorney is governed by the laws of the State of [STATE NAME].

Signed on [MM/DD/YYYY].

________________________________
Principal’s Signature

[PRINCIPAL PRINTED NAME]

Principal’s Print Name

ACCEPTANCE OF APPOINTMENT

I, [AGENT / ATTORNEY-IN-FACT NAME], the attorney-in-fact named above, hereby accept

appointment as attorney-in-fact in accordance with the foregoing instrument.

________________________________
Attorney-in-Fact’s Signature

[AGENT / ATTORNEY-IN-FACT PRINTED NAME]

Attorney-in-Fact’s Printed Name

WITNESSES

We, the witnesses, each do hereby declare in the presence of the principal that the principal signed
and executed this instrument as his Power of Attorney in the presence of each of us, that he signed
it willingly, that each of us hereby signs this Power of Attorney as witness at the request of the
principal and in his presence, and that, to the best of our knowledge, the principal is eighteen years
of age or over, of sound mind, and under no constraint or undue influence.

________________________________ [WITNESS (1) ADDRESS]

Witness Signature Address

[WITNESS (1) PRINTED NAME] [WITNESS (1) CITY, STATE, ZIP]

Witness Print Name City, State & Zip Code

________________________________ [WITNESS (2) ADDRESS]

Witness Signature Address

[WITNESS (2) PRINTED NAME] [WITNESS (2) CITY, STATE, ZIP]

Witness Print Name City, State & Zip Code

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ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF [NOTARY ONLY: STATE]

COUNTY [NOTARY ONLY: COUNTY]

On [NOTARY ONLY: MM/DD/YYYY], before me appeared

[NOTARY ONLY: PRINCIPAL NAME], as Principal of this Power of Attorney who proved to me
through government issued photo identification to be the above-named person, in my presence
executed foregoing instrument and acknowledged that he executed the same as his free act and
deed.

_________________________________________
Notary Public

My commission expires: [NOTARY ONLY: MM/DD/YYYY]

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GENERAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

THAT I/WE, ____________________, Filipino/ U.S. citizen(s), of legal age(s),

single/married to __________________________________________ and resident(s) of
________________________________do hereby appoint, name and constitute
______________________________, Filipino/ U.S. citizen, of legal age, single/married and resident of
________________________________ to be my/our true and lawful attorney to act in, manage and
conduct all my/our affairs and for that purpose in my/our name(s) and on my/our behalf
to do and execute any or all of the following acts, deeds, and things, to wit:

1. To exercise administration, general control and supervision over my/our

business and property in the Philippines, and to act as my/our general representative(s)
and agent(s) with full authority to buy, sell, negotiate, and contract for me/us and my/our
behalf;

2. To ask, demand, sue for, recover, and receive all sums of money, debts, dues,
goods, wares, merchandise, chattels, effects and things of whatsoever nature or description,
which now or hereafter shall be or become due, owing, payable or belonging to me/us, in
or by any right, title, ways or means howsoever, and upon receipt thereof or any part
thereof, to make, sign, execute and deliver such receipts, releases or other discharges;

3. To buy or otherwise acquire, to hire or lease, and to pledge or otherwise

hypothecate, assign, and to dispose of, any or all of my/our personal property or any
interest therein, upon such terms and conditions, and under such covenants, my/our
attorney(s) shall dim fit or proper, and to execute in my/our name(s) any and all papers
relating thereto, and to sign, execute, acknowledge and deliver any and all agreements, or
other writings therefore, or in any way connected therewith, or with any business or
property;

4. To deposit money and to withdraw same by check, receipt, draft or otherwise in

any bank in my/our name(s), to sign, endorse, draw, accept, make, execute, deliver and pay
checks, drafts, bills of exchanges, promissory notes, letters of credit, guarantees, and all
other writings, contracts and agreements;

5. To borrow any sum or sums of money that are urgent and indispensable for the
prevention of things which are under his/their administration on such terms, conditions,
and stipulations, and on such security, as my/our attorney(s) may think fit for that
purpose; to execute all promissory notes, bonds, mortgages, and other instruments which
may be necessary and proper;

6. To settle any account or reckoning whatsoever wherein I am/we are, or at any

time hereafter shall be in anywise, interested or are concerned with any person
whomsoever, and to pay or receive the balance thereof as the case may be;

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7. To compound with or make allowances to any person for and in respect to any
debts or demand whatsoever which now is or shall any time hereafter become due and
payable to me/us, and to take and receive any composition or dividend thereof or
thereupon and to give releases or other discharges for the whole of such debts or demands,
or to settle, compromise or submit to arbitration every such debts or demand and every
other right, matter and thing due to or concerning me/us as my/our attorney(s) may deem
advisable in the premises;

8. To make, sign, seal, execute and deliver contracts, documents, agreements and
other writings upon such terms and conditions acceptable to my/our said attorney(s);

9. In general, to do all other acts, deeds, matters and things whatsoever, in or about
my/our estate, property and affairs, or to concur with persons jointly interested with
myself/ourselves therein doing all acts, deeds, matters, and things herein, either
particularly or generally described, as fully and effectually to all intents and purposes as
I/we could do in my/our proper person(s) if personally present.

HEREBY GIVING AND GRANTING unto my/our said attorney(s) full power and
authority whatsoever requisite or proper to be done in or about the premises, as fully to all
intents and purposes as I/we might or could lawfully do if personally present, and hereby
certifying and confirming all that my/our said attorney(s) shall do or cause to be done
under these presents.

IN WITNESS WHEREOF, I/WE have hereunto set my/our hand(s) this ______ day of
_________ in the ______________________.

_______________________________ _____________________________
Signature Signature

SIGNED IN THE PRESENCE OF:

__________________________________________ _______________________________________
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SPRINGING POWER OF ATTORNEY

IMPORTANT INFORMATION

This power of attorney authorizes another person (your agent) to make decisions
concerning your property for you (the principal) when a designated condition is met. Your
agent will be able to make decisions and act with respect to your property (including your
money).

This power of attorney does not authorize the agent to make medical and health care
decisions for you.

You should select someone you trust to serve as your agent. Unless you specify otherwise,
generally the agent’s authority will continue until you die or revoke the power of attorney
or the agent resigns or is unable to act for you.

Your agent is entitled to reasonable compensation unless you state otherwise in the Special
Instructions.

This form provides for designation of one agent. If you wish to name more than one agent
you may name a co-agent in the Special Instructions. Co-agents are not required to act
together unless you include that requirement in the Special Instructions.

If your agent is unable or unwilling to act for you, your power of attorney will end unless
you have named a successor agent. You may also name a second successor agent.

If you have questions about the power of attorney or the authority you are granting
to your agent, you should seek legal advice before signing this form.

DESIGNATION OF AGENT
I, ________________________ of ________________________________________ [Address], authorize
________________________ of ________________________________________ [Address], as my agent
(attorney-in-fact) to act for me and in my name and for my use and benefit. If my agent is
unable or unwilling to act for me, I name ________________________ of
________________________________________ [Address] as my successor agent.
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GRANT OF GENERAL AUTHORITY

I grant my agent and any successor agent general authority to act for me with respect to the
following subjects:

Real property
Tangible personal property
Stocks and bonds
Commodities and options
Banks and Other Financial Institutions
Operation of Entity or Business
Insurance and Annuities
Estates, Trusts, and Other Beneficiary Interests
Claims and Litigation
Personal and Family Maintenance
Benefits from Governmental Programs or Civil or Military Service
Taxes

GRANT OF SPECIFIC AUTHORITY (OPTIONAL)

CAUTION: Granting any of the following will give your agent the authority to take actions
that could significantly reduce your property or change how your property is distributed at
your death.

Create, amend, revoke, or terminate an inter vivos trust

Make a gift
Create or change rights of survivorship
Create or change a beneficiary designation
Authorize another person to exercise the authority granted under this power of
attorney
Waive the principal’s right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan
Exercise fiduciary powers that the principal has authority to delegate

LIMITATION ON AGENT’S AUTHORITY

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An agent that is not my ancestor, spouse, or descendant may not use my property to
benefit the agent or a person to whom the agent owes an obligation of support unless I
have included that authority in the Special Instructions.

SPECIAL INSTRUCTIONS (OPTIONAL)

You may give special instructions on the following lines:

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
__________________________________________

EFFECTIVE DATE

This power of attorney is effective when:

☐I am incapacitated. I am declared incompetent by:

☐My attending physician.
☐A licensed physician.
☐Two licensed physicians.

☐A specific condition is met. The following condition is met:

___________________________________.

TERMINATION
☐If the power of attorney is effective upon your incapacitation. This power of attorney
shall not be affected by my subsequent disability or incapacity, or lapse of time.

☐If the power of attorney is effective upon a specific condition:

☐DURABLE Power of Attorney. This power of attorney shall not be affected by my

subsequent disability or incapacity, or lapse of time.

☐REGULAR Power of Attorney. This power of attorney shall terminate if I become

disabled or incapacitated.

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 NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If it becomes necessary for a court to appoint a guardian of my estate or my person, I

nominate the following person(s) for appointment:

Name of Nominee for guardian of my estate: _________________________________________

Nominee’s Address: _____________________________________________________________
Nominee’s Telephone Number: ____________________________________________________

Name of Nominee for guardian of my person: ________________________________________

Nominee’s Address: _____________________________________________________________
Nominee’s Telephone Number: ____________________________________________________

RELIANCE ON THIS POWER OF ATTORNEY

Any person, including my agent, may rely upon the validity of this power of attorney or a
copy of it unless that person knows it has terminated or is invalid.

SIGNATURE AND ACKNOWLEDGMENT

____________________________________ _________________________________
Signature of Principal Date

____________________________________
Name Printed

__________________________________________________________________________
Address

____________________________________
Telephone Number

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