SPECIAL POWER OF ATTORNEY

I, _____________________, Filipino, of legal age, and a resident of 162 F. Cruz St.,

Patoros, Metro Manila, do hereby name, constitute and appoint
________________________-, of legal age, single, residing at 406 Masilang St., Pineda,
Pasig city to be my true and lawful attorney-in-fact, for me and in my name, place and
stead and to do the following:
Apply, sign, assist, or follow-up my request regarding the petition for correction of clerical
error in the certication of live of birth filed by the undersigned in the Civil Registry Office
of the City of Manila, and for other acts relevant thereto.
HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and
authority whatsoever requisite or necessary or proper to be done in and about the
premises as full to all intents and purposes as I might and could lawfully do if personally
present, with power of substitution and revocation, and hereby, ratifying and confirming
all that my said attorney or her substitute shall lawfully do or cause to be done under and
by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ January 2020 at Pasig
City.

SIGNED IN THE PRESENCE OF:

_________________________ _________________________

REPUBLIC OF THE PHILIPPINES)

PASIG CITY) S.S.

ACKNOWLEDGMENT
BEFORE ME, a notary public, on ___ 2020 at Pasig City, personally appeared
ADELAIDA M. ISON and exhibited to me his Senior Citizen ID No. 4442 issued by Office of
the Senior Citizens Affairs. Known to me and to me known to be the same person who
executed the foregoing Special Power of Attorney and she acknowledged before me that
the same is her own free and voluntary act and deed.
WITNESS MY HAND AND SEAL, on the date and place above-written.

Doc. No. _____

Page No._____
Book No. _____
Series of 2020

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