SPECIAL POWER OF ATTORNEY

I, _________________, married, of legal age, Filipino, and a resident of

_________________, do hereby name, constitute and appoint _________________, of legal age,
married, Filipino, and a resident of _________________, as my as my AUTHORIZED
REPRESENTATIVE to personally claim the Owner’s Duplicate Copy of Transfer Certificate of
Title No. _________________ registered under my name and other related documents, if any, from
the Registry of Deeds of Virac, Catanduanes, and to be my true and lawful ATTORNEY-IN-FACT,
to do and perform the following acts, in my name and on my behalf, to wit:

1. To secure, receive, and sign for and in my behalf any and all applications, papers, and/or
documents necessary or incidental to the release of the the Owner’s Duplicate Copy of
Transfer Certificate of Title No. _________________ registered under my name, covered
by Assessment Form and Payment Order dated July 19, 2020 with EPEB no.
_________________, and/or other related documents before the Registry of Deeds of
Virac, Catanduanes; and
2. To do any and all other acts, deeds, matters and things whatsoever in or about the above
document, as fully and effectually to all intents and purposes as I could do in my own
proper person if personally present, and those which are necessary to carry out the
purpose of this instrument.

THAT, HEREBY GIVING AND GRANTING unto the said attorney-in-fact full power and
authority to do and perform all and every act and thing whatsoever requisite and necessary to be done
in and about the above premises, as fully to all intents and purposes as I might or could do if
personally present, and hereby ratifying and confirming all that said attorney-in-fact shall lawfully do
or cause to be done by virtue of this Special Power of Attorney.

THAT, this Special Power of Attorney shall be effective as of the date hereof and shall
remain in full force and effect until the earlier termination of the attorney-in-fact having performed
all actions requisite and necessary to be done in and about the above premises; provided, however,
that all acts lawfully done or performed prior to the execution of, but however, still pursuant to this
Special Power of Attorney by the said attorney-in-fact shall be, and the same hereby are, ratified and
confirmed.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 29 th day of July 2021 in
Legazpi City, Albay.

_________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

LEGAZPI CITY, ALBAY ) S.S.

BEFORE ME, this 29th day of July 2021, in Legazpi City, Albay, personally appeared:

Name Competent Evidence of Identity

known to me and to me known to be the same person who executed the foregoing instrument and he
acknowledged to me that the same is his free and voluntary act and deed. This instrument refers to a
SPECIAL POWER OF ATTORNEY which consists of one (1) page, including the page whereon this
acknowledgment is written, and which is signed by _________________ on each and every page
thereof.

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

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2021.
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