SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS: 

We,

1. __(names of respondents)___

Address:

2. ________

address

etc,

all of legal age, Filipinos, do hereby name, appoint, and constitute (name of
representative) with address at ___________, to be our true and lawful attorney-
in-fact, for us and in our name, place and stead, to do and perform the following
acts and things, to wit:

a.) To appear and represent us all in the case entitled

______________________ with case no. __________________ pending before
the ______________ of the Social Security System in __(address)_ for
the hearing set on 4 March 2020 at (time);

b.) To ask for a resetting on our behalf to give us time to secure

the services of legal counsel to assist us in this case;

c.) To do and perform any other acts in connection with, or

necessary to carry out, the above undertaking;

HEREBY GIVING and GRANTING unto said Attorney-in-Fact full powers

and authority to do and perform every act necessary to render effective the
foregoing, as though we have so performed it, and HEREBY APPROVING ALL
that he/she may do by virtue hereof with full right of substitution of his/her
person and revocation of this instrument.

IN WITNESS WHEREOF, I have here unto signed this instrument this

_____________________ at __________________.
 ____(names and signatures of all
persons above)_______

REPUBLIC OF THE PHILIPPINES)

CITY OF ) S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in __________________, this

_______________________, personally appeared the affiants:

Names and IDs of affiants

known to me to be the same persons who executed the foregoing instrument

and acknowledgment to me that the same is their free act and voluntary deed.

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

Doc. No. ______;

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