SPECIAL POWER OF ATTORNEY

I, ___________________, of legal age, single, Filipino, and residing at

________________________, do hereby name, constitute and point, ________________________, of
legal age, married, Filipino, and a resident of ________________________, to be my true and lawful
attorney-in-fact, for me and in my place and stead to process, to sign, to receive my ______________
and any future documents related to me.

HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact full power and authority to do and
perform any and every act requisite and necessary to be done in and about the premises as fully to all intents
and purposes as I might or could do, I personally present and acting in person, HEREBY RATIFYING AND
CONFIRMING all that my said Attorney-in-Fact may also do or cause to be done under and by virtue of these
presents.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _________, 20___ at the
Province/City of ______________________________.

___________________________ ___________________
Attorney-in-fact PRINCIPAL

SIGNED IN THE PRESENCE OF:

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

PROVINCE/CITY OF ____________) S.S.

BEFORE ME, A Notary Public for and in the _______________________, Province of

_____________________, this ______ day of _____________, 20______, personally appeared the above-
named persons, who has satisfactorily proven to me their identity through their identifying documents written
below their name and signature, that they are the same person who executed and voluntarily signed the
foregoing Special Power of Attorney, which he/she acknowledged before me as his/her free and voluntary act
and deed.

WITNESS MY HAND AND NOTARIAL SEAL.

NOTARY PUBLIC

Doc. No. _________;

Page No. ________;
Book No._________;
Series of _________