You are on page 1of 2

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, BERNADETTE SIMAN LUMBA, Filipino, of legal age, married, and with


postal address at Block 1 Lot 2 Lynville Homes, Brgy. Bagumbayan, Santa Cruz,
Laguna, do hereby name, constitute and appoint RAY FRANCIS MART
CALISAY LUMBA, Filipino, of legal age, married and with postal address at Block
1 Lot 2 Lynville Homes, Brgy. Bagumbayan, Santa Cruz, Laguna, as my true and
lawful Attorney-In-Fact to manage and conduct all my affairs and for that purpose,
in my name and on my behalf, to do and execute any or all of the following acts,
deeds, and things, to wit:

1. To execute, sign, and claim my Medicare (PhilHealth Honorarium,


any and all sums of money/checks from the Provincial Government
of Laguna (PGL) and from all other concerned government
departments and/or agencies;

2. To execute, and sign my papers in any document that I may need;

3. To receive documents, checks or cash relating to the mentioned


transactions;

4. To perform all acts necessary and desirable for the accomplishment


of the aforesaid acts.

HEREBY GRANTING unto my Attorney-In-Fact Full power and authority


whatsoever requisite, necessary ad proper to be done in or about the premises,
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 Attorney-In-Fact shall
do or cause to be done under and by virtue of these presents.

IN WITNESS WHEREOF, we have hereunto set our hands this 26 th day of


February 2020 at Paete, Laguna.

BERNADETTE SIMAN LUMBA RAY FRANCIS MART C. LUMBA


Principal Attorney-in-Fact

Signed in the presence of:

_________________________ __________________________
ACKNOWLEDGMENT

Republic of the Philippines )


Province of Laguna) S.S
Municipality of Paete)
x------------------------------------x

BEFORE ME, personally appeared:

VALID ID VALID UNTIL

BERNADETTE SIMAN LUMBA PRC ID NO. 0741912 07-16-2021


RAY FRANCIS MART C. LUMBA Passport No. P6181215A 02-25-2028

known to me and to me known to be the same persons who executed the


foregoing instrument and acknowledged to me that the same is their free and
voluntary act and deed.

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

Doc. No. 115 ;


Page No. 28;
Book No. 2;
Series of 2019.

You might also like