SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS: I, (name of person

authorized to claim the smart card kit), of legal age, Filipino, holding the position
of (position), (department/office in PhilPaSS-participant bank), (name of PhilPaSS-
participant bank), with office address at (office address), pursuant to Board
Resolution dated _____________ and reflected in the attached Secretary’s
Certificate, do hereby appoint, name and constitute, (name of employee of
PhilPaSS-participant bank), (position), (department/office in PhilPaSS-participant
bank) of (name of PhilPaSS-participant bank), as my true and lawful attorney-in-
fact, for me and in my name, place and stead, to accept/pick-up the following
smart card kit/s (smart card, smart card reader, and smart card account
envelope): Name of Authorizer

(add rows, as may be necessary)

Hereby giving and granting unto my said attorney-in-fact full power and authority
to do and perform every act and thing whatsoever requisite and necessary to be
done in and about the premises as fully to all intents and purposes as I might or
could lawfully do if personally present hereby ratifying and confirming all that my
said attorney-in-fact shall lawfully do or cause to be done by virtue of these
presents.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of

_______ 2014 at __________________.
 (name of person authorized to claim the smart card kit) Principal

ACKNOWLEDGMENT

Republic of the Philippines ) ______________________ )S.S.

Before me, a Notary Public for and in the City of ___________, on this ______ day
of _________ 2014, appeared (name of person authorized to claim the smart card
kit) with (competent evidence of identity) issued on (date of issue) at (place of
issue), known to me and to me known to be the same person who executed the
foregoing instrument and acknowledged to me that the same is his free and
voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand, the day, year and place
abovewritten. NOTARY PUBLIC Doc. No. ______; Page No. ______; Book No.
______; Series of 2014.