SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ______________, single, of legal age, Filipino citizen, with office address

at ______________________, Attorney-in-fact of _________________, do
hereby NAME, CONSTITUTE and APPOINT _____________________, Liason
Officer of _________________________________, of legal age, Filipino citizen,
with office address at __________________________, to claim TCT No.
______________________with an annotation of a Affidavit of Loss in relation
to the loss of the _____________________ owners’ duplicate copy of Transfer
Certificate of Title No. _______________________, for the Register of Deeds of
the Province of Laguna, and more particularly described as follows:

TCT No. _________

“A parcel of land _______________________”

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
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 and hereby ratifying
and confirming all that my said attorney-in-fact may lawfully do or cause to be done
by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this _____day of

__________ 2019 in ________________.

NAME
Principal

Signed in the presence of:

________________________ ________________________

Republic of the Philippines )

City of __________ ) S.S.

ACKNOWLEDGMENT

BEFORE ME, this _____ day of ________ 2019 in the City of

__________________, Philippines, personally appeared
_____________________, with his Driver License No. _____________________
valid until _______________________ issued by the Land Transportation Office
known to me to be the same person who executed the foregoing Special Power of
Attorney, and he acknowledged that the same is his free and voluntary act and
deed.

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

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NOTARY PUBLIC

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.