SPECIAL POWER OF ATTORNEY

I, ___________________, of legal age, married, Filipino with residence at

____________________________________________________________________, do hereby name appoint,

_______________________ of legal age, and with residence at ________________________________________,

as my Attorney-in-Fact with the full authority to act on my behalf to complete and sign my name on any document
or form that is legally required in order to complete transactions for the vehicle listed below:

MAKE : ENGINE NO. :

SERIES : SERIAL/CHASSIS NO. :
TYPE OF BODY : PLATE NO. :
YEAR MODEL : FILE NO. :
OR NO. (2017) : C.R. NO. :

The following transactions are hereby authorized:

1. To make, sign and execute, for and in my behalf, any documents which may be necessary for the transfer
of the motor vehicle ownership;
2. To represent and transact official business with the Security , Land Transportation Office (LTO) and Office
of the Registry of Deeds (RD) and other agencies in connection with the cancellation of mortgage and
transfer of motor vehicle.

This document shall be construed and interpreted as a limited and special power of attorney which is valid only for
the purposes, persons and vehicle stated herein and may not be used for any other transaction or by any person not
named.

I confirm that I have the legal right to execute this Power of Attorney and that the information supplied in supporting
documents are true and correct.

IN WITNESS WHEREOF, I hereunto signed my name this _______ day of July, 2018, at
______________________________.

Principal

Attorney-in-fact

SIGNED IN THE PRESENCE OF:

_______________________________ __________________________________
 ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF ____________________) S.S.

BEFORE ME, a Notary Public for and in above jurisdiction this ___day of _______personally appeared with
Identification No._________________________, known to me to be the same person who executed the foregoing
instrument and who acknowledged to me that the same is HER free and voluntary act and deed.

The instrument consisting of TWO (2) pages including this acknowledgement is written, has been signed by the
parties together with their instrumental witnesses, and refers to a Special Power of Attorney.

WITNESS MY HAND AND SEAL on the date and at the place first above written.

Doc. No. ____

Page No.____
Book No.____
Series of 20__