SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ____________, of legal age, single, Filipino, and a resident of _____________,

Philippines, after having been duly sworn to in accordance with law, do hereby NAME,
CONSTITUTE, and APPOINT ___________, of legal age, Filipino and a resident of
____________, Philippines, to be my true and lawful Attorney-in-Fact, in my name and my
behalf, to do and perform all or any of the following acts:

1. To represent me before the Land Transportation Office (LTO) with regard the
impounded motor vehicle bearing the Plate Number _________ with Certificate of
Registration No. _______ and Official Receipt No. ___________;

2. To pay the penalties and other fees with respect to the impounded motor vehicle;

3. To process the renewal of the registration of the aforementioned motor vehicle;

4. To comply with all the requirements required of by the LTO so that the
impounded motor vehicle can be released and thereafter, to release the same vehicle
to Mr. ________, in my behalf; and

5. To sign documents and do any other acts necessary for the performance of the
above-stated authority.

HEREBY GIVING AND GRANTING my said Attorney-in-Fact full powers and

authority to do and perform all and every act requisite or necessary to be done, as fully to
all intents and purposes as I might or could lawfully do if personally present, and hereby
ratifying and confirming all that my said attorney-in-fact shall do or cause to be done by
virtue of these presents.

______________________
Principal/Grantor
I.D. No. _______________

_________________________
Attorney-in-fact/Grantee
I.D. No. _______________

REPUBLIC OF THE PHILIPPINES)

CITY OF _______________)SS.
x-------------------------------------------x
ACKNOWLEDGMENT

BEFORE ME, Notary Public, for and in the City of ________, Philippines, this
______ day of _____________, personally appeared the parties, known to me and to me
known to be the person who executed the foregoing instrument and acknowledged that
the same is his own free will and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and in the place first above written.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2017.