SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________ , is of legal age, single and with residence and postal
address at _______________________________________, do hereby name, constitute, and
appoint and by these presents have named, constituted and appointed
__________________________, also of legal age, Filipino and with residence and postal
address at ______________________________, to be my true and lawful ATTORNEY-IN-FACT, for
me and in my name, place and stead, to do and perform the following acts and things:

To appear as atty-in-fact and represent for and in my behalf in my petition for

issuance of another owner’s duplicate Transfer Certificate of Title No.
________________;

To represent me and appear in my behalf in all the hearings of the said petition
and to testify in my behalf;

To make admissions, stipulations of facts and to submit and present

documentary exhibits in my behalf;

To testify and identify documentary evidences;

To execute and sign for me and in my behalf any document necessary to

accomplish the said purpose/s;

HEREBY GIVING AND GRANTING unto said Attorney-in-fact full power and authority to
do and perform all every act required or necessary to carry into effect the foregoing authority as
fully to all intents and purposes as I might or could lawfully do as if personally present with full
power of substitution and revocation and hereby ratifying and confirming all that my said Attorney-
in-fact shall lawfully do or cause to be done by virtue of these presents.
IN WITNESS WHEREOF, we have hereunto affixed our signatures this ______ day of
___________________ in the City of Caloocan, Metro Manila.

___________________ ___________________
Principal Atty-in-Fact
Sign In The Presence Of: _____________________/ / _____________________

ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
CALOOCAN CITY )S.S.
BEFORE ME, a Notary Public for and in Caloocan City, on this _____ day of __________,
personally appeared: ___________________with ID
No.___________________and___________________with ID No. _______________both
known to me to be the same persons who executed the foregoing instrument and acknowledged to
me that the same is their own and free voluntary and deed.
WITNESS MY HAND AND SEAL on the date and place first above written.

Doc. No. ___________

Page No. ___________
Book No. ___________
Series of 2017