SPECIAL POWER OF ATTORNEY

KNOWN ALL MEN BY THESE PRESENTS:

WE, _________________, both of legal age, Filipino, and a resident of

_____________________, do hereby name, constitute, and appoint ____________ and/or both of
legal age, Filipino and a resident of _____________, to be our true and lawful attorney-in-fact, to do
and perform the following acts:

1. To apply, process, pay, obtain, and receive a copy__________________.

HEREBY GIVING AND GRANTING unto our Attorney-in-Fact full power and authority
whatsoever requisite and necessary proper to be done in and about premises as fully to all intents and
purposes as our might and lawfully do if personally present and shall be lawfully do or cause to be
done under and by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hands at _______________ on this day of

____________ 2021.

AFFIANT

SIGNED IN THE PRESENCE OF:

______________________ & ___________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) S.S

X---------------------------------------------X

BEFORE ME, personally appeared ____________ with valid ID's stated above, known to me
to be the same persons who executed the foregoing Special Power of Attorney and they acknowledge to
me that same and true act and voluntary deed.

IN WITNESS WHEREOF, I have hereunto affix my signature and notarial seal this
____________ of 2021 at the _______________.

Doc. No.
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Book No.
Series of 2021