SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, _____________________________, of legal age, Filipino,
single/married,
with
permanent
address
at
________________________________________, Philippines, holder of Philippine
Passport no. __________ issued on _______ at ________________, and presently
residing at _______________________________________ have NAMED,
APPOINTED
and
CONSTITUTED,
Mr./Ms._________________________________, likewise of legal age, Filipino and
presently residing at ___________________________
______________________ Philippines, my true and lawful ATTORNEY-IN-FACT,
for me and in my name, place and stead, for my own use and benefit, to do any or all
of the following acts and things to wit:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_________________________________

HEREBY GIVING AND GRANTING unto said Attorney-in-fact, full power

and authority to perform each and every act and thing whatsoever requisite or
necessary to be done in and about the premises, as fully to all intents and purposes as I
might or could do if personally present and acting, and hereby ratifying and
confirming all that my said Attorney-in-fact shall lawfully do or cause to be done
under by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto set my hand this
__________________ at the Consular Section of the Philippine Embassy in Riyadh,
Kingdom of Saudi Arabia.

_________________________________
Principal
(Name and Signature)
________________________
(Attorney-in-fact)
SIGNED IN THE PRESENCE OF:

1. _________________________
Witness
Name and Signature

2. _________________________
Witness
Name and Signature