SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS :

I, (name sa person na mag hatag ug authority), of legal age, Filipino, married

and a resident of ______________, do hereby name, constitute and appoint, (name sa
person na iauthorize), likewise of legal age, Filipino, married and a resident of
____________, Philippines, to be my true and lawful Attorney, for me and in my name,
place and stead, to do and perform the following acts and things, to wit:

1. To pay my contributions to the Social Security System, Panabo City

relative to a ______________ (indicate the object/purpose of
payment);

2. To sign documents and other instruments in the course of implementing

the foregoing powers and authority herein granted with the concerned
government offices/agencies.

HEREBY GRANTING unto my said attorney full powers and authority to do and
perform all and every act requisite or necessary to carry into effect the foregoing
authority, as fully to all intents and purposes as I might or could lawfully do if personally
present, with full 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 by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

Tagum City, Philippines.

_____________
Principal
Accepted by:
_____________
Attorney-in-Fact

SIGNED IN THE PRESENCE OF

_________________________ and _______________________

ACKNOWLEDGMENT

Republic of the Philippines. )

Province of Davao del Norte) s.s.
City of Tagum . . . . . . . . . . . )
x..................... x

BEFORE ME, this _____________ at _____________, personally appeared

_____________ with _____________, known to me to be the same person who
executed the foregoing instrument and he acknowledged to me that the same is his true
and voluntary act and deed.

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 ​WITNESS MY HAND AND SEAL on the date and place stated above.
Doc. No. ___
Page No.___
Book No.___
Series of 2019

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