SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, , of legal age, Filipino citizen, and a resident of City,

Philippines, hereby NAME, CONSTITUTE, and APPOINT my,
likewise of legal age, Filipino Citizen, presently residing at City,
Philippines to be my true and lawful attorney-in-fact for me and in
my name, place, and stead, to perform any and all of the following
acts, to wit:

1. To process and transact with the, Incorporated, for and in

my behalf with regard the insurance claim of;

2. To receive the proceeds of the insurance, in check or in

cash for and in my behalf;

3. In case of check, to encash or deposit the same as she

deems necessary;

4. To sign, execute, receive and/or deliver contracts and

agreements, other papers and/or money to effect with her
power stated in this authorization pertinent to the above
described authority.

HEREBY GIVING AND GRANTING unto my said attorney in

fact full power and authority to do and perform all 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 do if
personally present and hereby ratifying and confirming all that my
said attorney in fact shall lawfully do or cause to be done by virtue
thereof.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th

day of October 2018.

_____________________
Passport No.:
Issued on
Issued in
With my conformity:

_______________________
Republic of the Philippines )
) S.S.
Done in the City of )

ACKNOWLEDGEMENT