SPECIAL POWER OF ATTORNEY

KNOWN ALL MEN BY THESE PRESENTS:

I ________________, of legal age, single/married, resident of __________________________,

do hereby name, constitute, and appoint __________________, to be my true and lawful attorney, for
me and in my name, place, and stead, to do and perform the following acts and things to wit:

To make, sign, execute, and deliver contracts, documents, agreements, and other writings of
whatever nature or kind, with any and all third persons, concerns, or entities, upon terms and conditions
acceptable to my said attorney;

To delegate in whole or in part any or all of the powers herein granted or conferred, by means
of an instrument in writing, in favor of any third person or persons whom my said attorney may select;

HEREBY GIVING AND GRANTING unto my said attorney full power and authority whatsoever
requisite or necessary or proper 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, with power of substitution and revocation,
and herby, ratifying and confirming all that my said attorney or his substitute shall lawfully do or cause
to be done under and by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of ___________, 2 ___, in
__________________, Philippines.

________________________
Principal

WITNESSES:

___________________________ _____________________________

ACKNOWLEDGEMENT

SUBSCRIBED and sworn to before me, in the City/Municipality of ___________, this day of ___,
20___ by _________________ with Residence Certificate No. __________ issued at ___________, on
____________ 20 ____.

Notary Public

Doc. No. ____

Page No.____
Book No.____
Series of ____