SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________-, of legal age, Filipino citizen with residence and postal address at
______________________ do hereby NAME, CONSTITUTE, and APPOINT
_________________________ with principal office address at
______________________________ as my true and lawful attorney-in-fact, to act for and in my
name and stead and to do the following acts:

To bring, file, initiate, and institute cases, complaints, petitions, and any and all actions
for and in my behalf, and to protect and vindicate my rights as to any and all matters affecting
my interests as well as to defend me in any and all actions that may be brought or filed against
me in any court, tribunal, administrative or quasi-judicial body or forum, with full and special
power and authority: (a) to cause and authorize the preparation and filing of all pleadings,
motions, memoranda, affidavits, and such other papers or documents as may be needed in the
course of trial; (b) to sign and execute all verifications and certifications of non-forum shopping
and other procedural requirements for pleadings filed on my behalf for any and all cases
instituted or to be instituted by or against me; (c) to appear for and in my behalf in all mediation
proceeding; (d) to compromise;

To be my true and lawful Attorney-in-Fact at all the hearings, proceedings, mandatory

conference, mediation and judicial dispute resolution proceedings and all incidents of the
_________________________ to filed on such date or dates as may be agreed upon by the
parties of directed by the Honorable Court with full and special power and authority (A) to enter
into an amicable settlement, (B) to submit to alternative modes of dispute resolution, including
but not limited to mediation and judicial dispute resolutions (C) to enter into stipulations or
admissions of facts and of documents, and (D) to appear at the mandatory conference, (E) to
compromise, (F) to sign and execute all verifications and certifications of non-forum shopping
and other procedural requirements for pleadings filed for and on my behalf, (G) to cause and
authorize the preparation and filing of all pleadings, motions, memoranda, affidavits, and such
other papers or documents as may be needed for the prosecution of the above stated case;

To further authorize ___________________________ to cause the preparation, execute

and sign pleadings, motions, memoranda and such other documents as may be needed in the
course of the trial, as well as to submit and present evidence in for and in my behalf;

To make, accomplish, sign and execute any or all papers, documents in my name that
may be necessary or requisite to carry out the above stated purposes;

HEREBY GIVING AND GRANTING unto my said representative full power and
authority to execute and perform all and every act requisite and necessary to carry into effect the
foregoing authority, as fully to all intents and purposes as though I myself, has so performed it,
and HEREBY APPROVING ALL that he may do by virtue hereof with full right of substitution
of his person and revocation of this instrument.

IN WITNESS WHEREOF, I have hereunto set my hand this __________, in Angeles

City.

_____________________
 __________________

Conforme:

REPUBLIC OF THE PHILIPPINES )

ANGELES CITY ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public, this ____________ at ____________________ personally

appeared known to me the same person who executed the foregoing Special Power of Attorney
for which she acknowledged to be her personal voluntary act and deed.