Republic of the Philippines}

___________________} s. s.
x-------------------x

SPECIAL POWER OF ATTORNEY

I, _________________________________________, of legal age, Filipino, married, and

now residing at ____________________________________________________________-,
after being duly sworn to in accordance with the law, do hereby depose and state THAT:

In connection with my claim to bank account/s of deceased depositor

___________________________________________________to wit:

BANK BRANCH/ADDRESS

I hereby name, constitute and appoint ________________________________________,

of legal age, Filipino, and residents of
________________________________________________, as my true and lawful ATTORNEY-
IN-FACT, for me/us and my name, place and stead, for my/ our own use and benefit, to do and
perform any or all of the following acts and things:

(a) To inquire, file and/or process my claim to the bank account/s of the aforementioned
deceased depositor;

(c) To make, sign, execute, submit or deliver, for and in my behalf, any document/s necessary
for claim to the bank account/s of the deceased depositor before any of the aforementioned
banks, and/or any private institution and/or any government agency;

(d) To withdraw the funds and/or to receive and/or claim, in cash or check, the amount of
deposit and close the account/s of the deceased depositor;

(e) To do all other acts necessary for the attainment and accomplishment of the above-
mentioned transaction and/or to give effect to the foregoing authority;

HEREBY GIVING AND GRANTING unto my Attorney-in-Fact full power and authority to
do and perform all and every act and thing whatsoever requisite, necessary or proper to be done
and about the premises as fully to all intents and purposes 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 or cause to be done under and by virtue of these presents.

IN WITNESS WHEREOF, I hereby affix my signature this ______________________ at

________________________________________, Philippines.

ACKNOWLEDGMENT

BEFORE ME, this ______________________ at Gen. Santos City, Philippines, affiant

personally appeared and acknowledged that he personally executed the foregoing document
as his free and voluntary act and deed, after exhibiting his proof of identity as follows:

NAME ID TYPE & NO. VALIDITY

WITNESS MY HAND AND SEAL.

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

SPECIAL POWER OF ATTORNEY