SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS: I, ____________________________, of legal age, single/married/widow, Filipino, and a resident of ____________________________________by virtue of these presents, do hereby NAME, CONSTITUTE, and APPOINT, _______________________________, of legal age, single and resident of ________________________________________, to be my true and lawful Attorney-In-Fact, for me and in my name, place, behalf, and stead, do the following acts or things, to wit: To represent, act and sign for and in my behalf; to process, follow-up, deliver, execute and sign any and all legal documents with ______________________________ in connection with ___________________________________________________________________ ________________________________________________________________; and to deliver, execute and sign any and all legal documents in connection with the above-given authority. HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and authority to do and perform all and every acts requisite and necessary to carry into effect the foregoing authority, 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 shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ September 2012, in the ______________________________. _____________________________________________ Principal Conforme: _________________________ Attorney-In-Fact Signed in the presence of: ____________________ & __________________

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES) CITY OF ILOILO) S. S. x---------------------------------------x BEFORE ME, this ____ day of September 2012 in the City of Iloilo, personally appeared ________________________________ exhibiting to me Passport ID No. ____________________ issued on _________________ at ___________________, known to me to be the same person who executed the foregoing instrument and she acknowledged to me that the same is her free act and voluntary deed. WITNESS MY HAND AND SEAL on the date, year, and place above-written.

Doc. No. _____; Page No ._____; Book No. _____; Series of 2012.