SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, __________________________, represented by ____________________________________________

_____________________ with business and office address at ___________________________________________, do HEREBY
NAME, CONSTITUTE and APPOINT , ___________________________________________ Represented by:
___________________________________________, of legal age, Filipino, with business and office address at
_______________________________, to be my true and lawful Attorney-in-fact, for me and in my name, place and
stead and to perform on my behalf the following:

1. To transact/process my ATP Application for Authority to Print Receipts and Invoices of

my business firm known as ___________________________________________, located at
___________________________________________ with the office of BIR,
___________________________________________

2. To sign in my behalf all pertinent papers/documents relative to the above transactions;

3. To claim and receive the documents as well as pay the necessary fees in connection
with the above-mentioned purposes;

4. Such other matter to the foregoing powers and attorney for the full implementation
thereof.

HEREBY GIVING and GRANTING, unto my said attorney full power and authority to do and perform
all and every act requisite or necessary to carry into effect the foregoing authority as fully to all intents and
purposes as I might or could lawfully do if personally present, and hereby ratifying and confirming all that
my said attorney-in-fact shall lawfully do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, we have hereunto set our hands this

___________________________________________at ___________________________________________, Philippines.

___________________________________________
Represented by:_____________________________________
(Principal)
Conforme:
___________________________________________Represented by:_____________________________________
(Attorney-In-Fact)
SIGNED IN THE PRESENCE OF:
________________________ ________________________
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
DAGUPAN CITY………………….) S.S

BEFORE ME, a Notary Public, this ___________________________________________ at

___________________________________________, made known to me to be the same persons who executed the
foregoing instrument and they acknowledged to me under oath that the same is their free act and voluntary
deed.

WITNESS MY HAND AND SEAL.

Doc. No. ________; Notary Public

Page No. ________;
Book No. ________;
Series of 2022.