REQUEST FOR ISSUANCE OF SPECIAL POWER OF ATTORNEY

Company (SRSI, Date

SRMI, AJAI etc.): Requested:

Department: Date Needed:

Requested By:

Department
Head:

Detailed Description of what is being authorized (If it involves property/vehicle, state its particulars)

Name and Address of Principal:

ID to be presented by the Principal: (include ID no. To whom the property will be issued (if
and attach its copy) applicable):

To whom it will be submitted:

Name of Attorney-In-Fact/ person to be appointed for the transaction Number of Copies

(state the position): Required:

ID to be presented by the Attorney-In-Fact (include ID no. and attach its copy)

NOTE:

Date when the SPA is needed should not be less than five days from the date a proper request is
made unless it is urgent. If it is urgent, reason why it is urgent.