SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, , the General Manager of with Tax Payer

Identification Number (TIN) , a corporation/company duly recognized and
existing under and by virtue of the laws of the Philippines, with office located at
, do hereby name, constitute, and appoint , the site manager, as the authorized
representative of and be allowed to apply, sign,
process, transact, pay, and do the necessary actions related therein on behalf of the company in
furtherance of the electrical connection and water connection of the Temporary Facility built at
the located in . To do and perform any or all
the foregoing acts, to wit:
1. To apply, sign, transact, and process the application for electrical connection and
water connection.
2. To execute and/or deliver any and all documents, papers, instruments, forms,
agreements or contracts in connection with or as may be required, appropriate,
necessary, and/or incidental to the application of electrical and water connection; and
3. To do all other acts, deeds, matters and things whatsoever in connection with or as
may be required by, appropriate, necessary, and/or incidental to the said application.
HEREBY GIVING AND GRANTING full power and authority to do and perform any
and every act thing whatsoever required and necessary to be done as I might or could do, I
personally present and acting in person, HEREBY RATIFYING AND CONFIRMING all that
my said representative may also do or cause to be done under and by virtue of these presents.
IN WITNESS WHEREOF, I hereunto set my hand this _____ day of _____________
2024 at ________________ City.

__________________________________
______
(Name)
(Position)

SIGNED IN THE PRESENCE OF:

___________________________ ___________________________
Witness Witness

ACKNOWLEDGEMENT

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REPUBLIC OF THE PHILIPPINES)
CITY OF _____________________ ) S.S.

BEFORE ME, a notary public for and in __________ City this ____ of _______
2024, personally appeared:

Name Competent Date of Issue Date of Expiry

Evidence of Identity
No.

Who exhibited to me her/his competent evidence of identity and to me known to be the

same person who executed the foregoing instrument which consist of two (2) pages including the
page on which this acknowledgement is written, and who acknowledged to me that her signature
on the instrument was freely and voluntarily affixed by her for purposes stated therein.

IN WITNESS WHEREOF, I have hereunto set my hand at the place and date above
mentioned.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of ___

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