SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, NAME OF PRINCIPAL, Filipino Citizen, of legal age, married, with

residence at ADDRESS, do hereby name, constitute, and appoint and by these
presents do hereby name, constitute and appoint my wife, NAME OF ATTY IN FACT,
Filipino Citizen, of legal age, married and with the same residence as above, to be my
own and lawful Attorney-in-Fact, for me and in my name, place and stead, to do and
perform any and all of the foregoing acts and things, namely:

1. To represent me for and in my behalf in filing, applying for, processing

documents with COMPANY NAME (Company) in order to claim my last
paycheck;
2. To ask, demand, collect and receive all sums of money or credits either in
cash or check(s) payable or owing to me arising from the above
mentioned transaction;
3. To endorse and encash the aforementioned check(s), if any, with any
banking and financial institution duly authorized by the Bangko Sentral
ng Pilipinas;
4. To make, sign and execute, for and in my behalf, any documents and
papers with all and any third persons and entities in connection with the
above given powers and which may be necessary for the release of the
said checks; and,
5. To do and perform for and in my behalf acts which are related to the
above powers.

HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact full power and
authority to do and perform every act and thing whatsoever required and necessary to
be done in and about the premises, as fully to all intents and purposes as I might or
could lawfully do, if personally present, HEREBY RATIFYING AND CONFIRMING all
that my said Attorney-in-Fact or substitute shall lawfully do or cause to be done by
virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand on this ____ th day of

__________________, 2017 at San Pedro, Laguna.

NAME OF PRINCIPAL
Principal
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LAGUNA )
CITY OF SAN PEDRO ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in San Pedro, Laguna, personally
appeared:

Name ID No.
NAME OF PRINCIPAL ID

known to me and to me known to be the same persons who executed this

Special Power of Attorney and acknowledged to me that the same is their free
and voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal

this ____th of ____________________, 2017 in San Pedro, Laguna.

Notary Public

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.