State of Oregon

County of

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I/We, [Name/Names] of legal age, single/married to [Name], and a resident of

[address in USA], do hereby, appoint, name, and constitute [Name of your agent] of [Agents
address in the Philippines] to be my/our true and lawful attorney to do and execute the following
act in my/our name and on my/our behalf, to wit:

[Indicate here the specific act or acts your agent/attorney-in-fact will do on your behalf. Be
specific.]

HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and authority to
do and perform any and every act and thing whatsoever requisite or necessary or proper to be
done in and about the premises as fully to all intents and purposes as I/we might or could
lawfully do if personally present, with power of substitution and revocation, and hereby ratifying
and confirming all that my/our said attorney-in-fact shall lawfully do or cause to done under and
by virtue of these presents.

IN WITNESS WHEREOF, I hereby set my hand on [date] in [City], [State], USA.

With Marital Consent [If married]

[NAME] [NAME]

SUBSCRIBED AND SWORN to before me on _________________________ in Portland,

Oregon, USA.

Notary Public State of Oregon