SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, __________________________, of legal age, single, Filipino citizen and resident of

______________________________________________, do hereby name, constitute and appoint
_______________________________, of legal age and resident also of __________________________________, to be my
true and lawful attorney-in-fact, for me and in my name, place and stead, to do and perform the following
special powers, to wit:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and authority to do and perform
any and every act and thing whatsoever requisite, necessary or proper to be done in and about the
premises as fully to all intents and purpose as I might or could do if personally present and acting in
person; and

HEREBY RATIFYING AND CONFIRMING all that my said attorney-in-fact shall lawfully do and cause to be
done under by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand at ____________, Philippines, on this ____________ day of
________________, 20______.

____________________

Principal

Conforme:

______________

Attorney-in-fact

SIGNED IN THE PRESENCE OF:

____________________________                              ___________________________

ACKNOWLEDGMENT
Republic of the Philippines
Makati City ) S.S.

BEFORE ME, a Notary Public in and for Makati City, Philippines, this ______________ personally appeared:

Name                               Res. Cert.            Date/Place Issued

_________________          ____________      _________ _______

_________________          ____________      _________ _______

known to me to be the same persons who executed the foregoing instrument and they acknowledged to
me that the same is their free and voluntary act and deed.

IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my notarial seal on the date and at the
place first above written.

Doc No. _________

Page No._________

Book No. ________

Series of 20_______