SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________, of legal age, Filipino, single/married/widow and a resident of

________________________, Philippines, after having been duly sworn to in accordance with law, do
hereby name, appoint and constitute and by this presents ________________________, Filipino, of legal
age, single/married, with postal address at ____________________, Philippines, to be my true and lawful
attorney, to act on my behalf and in my name, and to do and perform the foregoing acts in connection with
my pension claims and legal benefits from the Armed Forces of the Philippines and the Philippine Veterans
Affairs Office, to wit:

1. To receive in my behalf all payments made by the above-mentioned government agencies,

whether through ATM, in cash or issued through cheque/s;

2. To process, transact and encash with the concerned banks the cheques received from the
above-mentioned government agencies, as well as deposit to my account all such cash
payments and proceeds received;

3. To sign, do and perform all acts and request pertinent documents that are necessary and
proper to attain the foregoing.

GIVING AND GRANTING unto the said ATTORNEY-IN-FACT full power and authority to do and
perform all and every act and deed whatsoever required and necessary to be done in and about the
premises, as fully as to all intents and purposes as I may lawfully do if personally present with all the power
of substitution or revocation and hereby RATIFYING and CONFIRMING all that my ATTORNEY-IN-FACT or
his substitute can lawfully do or cause to be done by virtue thereof.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 4 January 2019, at Quezon
City.

__________________________ __________________________
(NAME OF ATTY IN FACT) (NAME OF PRINCIPAL)
Attorney-in-Fact Principal

BEFORE ME, this ___________, personally appeared the affiant with ________________, known
to me and to me known to be thesame person who executed this foregoing instrument and hereby
acknowledged to me that the same is her free and voluntary act and deed.

This instrument consisting of one page, including this page on which this acknowledgment is
written refers to a SPECIAL POWER OF ATTORNEY and has been signed and sealed with my notarial
seal.

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

NOTARY PUBLIC

Doc No. _________;

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