SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ______________, of legal age, and resident of _________, do hereby name,
constitute and appoint ___________, of legal age, and resident of ____________, to be my
true and lawful Attorney-in-Fact and in my name, place and stead, do perform the
following specific act(s):
[SPECIFY THE ACTS TO BE PERFORMED]
Giving and granting unto said attorney-in-fact power and authority to do every act
necessary and required in connection with these presents, and hereby ratifying and
confirming all that said attorney-in-fact shall do or cause to be done under and by virtue
of these presents.
IN WITNESS WHEREOF, I have signed this Special Power of Attorney this _________
at __________.
(Sgd.) _____________
Principal
SIGNED IN THE PRESENCE OF:
(Sgd.) ______________
(Sgd.) ______________
[INCLUDE ACKNOWLEDGMENT AS PROVIDED BELOW]
Republic of the Philippines
City of Manila

)
) s.s.

BEFORE ME, this ____________ in the City of _____________, personally appeared

___________, with [VALID ID with ID No.] _______________ issued by the [ISSUING
AUTHORITY] ______________ on _____________, known to me to be the same person who
executed the foregoing instrument, and who acknowledged to me that the same is his
free act and deed.
IN WITNESS WHEREOF, I have set my hand and affixed my Notarial seal on the
day, year and place written.
(Sgd.) __________
Notary Public
Until__________________
PTR No. _______________
Issued at ______________
On ___________________