1/1

SPECIAL POWER OF ATTORNEY

I, _____, of legal age, and with address at _____, hereby appoint _____ as my duly constituted
Attorney-in-Fact to do and perform any and all of the following acts:

1. To transact with _____ for the purpose of _____;

2. To sign and/or obtain any and all documents and perform any such act/s as may be
necessary or appropriate to implement the foregoing authority.

Signed on ____________ in _____.

_________________________________
Principal

____________________________________
Attorney-in-Fact

ACKNOWLEDGEMENT

Republic of the Philippines)

_____ ) SS

BEFORE ME, a Notary Public for ____________, on ____________ in ____________,

personally appeared:

Name Identification Card Valid Until

identified by me through competent evidence of their identity bearing their respective

photographs and signatures to be the same persons who executed this Special Power of Attorney
and acknowledged to me that the same is their own free act and voluntary deed.

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

Doc. No. ;
Page No. ;
Book No. ;
Series of ____.