Commission on Elections FORM

May 13, 2019

National and Local Elections SPA-C

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, (name of candidate) , a candidate nominated by the (name of political

party/indicate “independent” if none) , for the position of (elective position sought), (district,
city/municipality, province of elective office) in the 13 May 2019 Elections, do hereby name,
constitute and appoint (name of representative or agent) , of legal age and a resident of
(address of the representative or agent) , to be my true and lawful attorney-in-fact for me, and in my
name, place and stead, to do and performing the following acts, to wit:

(1) To personally submit to the COMELEC office my Statement of Contributions and

Expenditures and all its required Schedules and supporting documents; and

(2) To receive any notice, whether in writing or verbally communicated to my attorney-in-fact,

which will then constitute as notice to me.

This special power of attorney, however, does not constitute a grant of authority to my
attorney-in-fact to sign the Statement of Contributions &Expenditures and the relevant attachments
(Forms 1-5), which is personal to me as a candidate and cannot be delegated to anyone.

I further declare that any act or thing lawfully done hereunder and within powers herein
stated by my said attorney-in-fact shall be binding on myself.

IN WITNESS WHEREOF, I and my attorney-in-fact hereby set our hands this (date when
this SPA is signed) , in the (place where this SPA is executed) .

(Name of Candidate) (Name of Representative-Agent)

PRINCIPAL ATTORNEY-IN-FACT/AGENT

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

City/Municipality of __________ )S.S.

BEFORE ME, on the date and place above written, personally appeared the following
persons with competent evidence of their identity:

Name ID ID No. Expiry Issuing

Document Date Authority

Said persons acknowledged under oath to me under penalty of law, that the whole contents of
this document are true and the same are their free and voluntary acts and deeds.

WITNESS MY HAND AND NOTARIAL SEAL.

Notary Public
Doc. No. : _____
Page No. : _____
Book No.: _____
Series of _____.