SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________, Filipino, legal age, married, with address at

__________________________________________________________, do hereby name,
constitute, and appoint ____________________________________, of legal age,
Filipino, with office address at ____________________________, to be my true and
lawful attorney, for me and in my name stead and place, to do and perform the
following acts, to wit:

To be my lawful representatives in the Pre-trial Conference of the case

where I am the complainant in the case of
“_____________________________________” docketed as
__________________________ for ________________________________ before
the __________________________________________; which includes among
others the power and authority to enter into stipulation of facts, cause
the marking of documents as exhibits, to submit to alternative modes of
dispute, including but not limited to mediation and judicial dispute
resolutions, enter into an amicable settlement/compromise agreement
and attend other proceedings required including all incidents of the case
on such date or dates as may be agreed upon by the parties or directed
by the Honorable Court.

HEREBY GIVING AND GRANTING unto my said attorney full power and
authority whatsoever requisite or necessary or proper to be done in and about
the premises as fully to all intents and purposes as we might lawfully do if
personally present, with power of substitution or revocation, and hereby
ratifying and confirming all that our said attorneys shall lawfully do or cause to
be done under and by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____

day of ________________, 2022 at the __________________.

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of

__________________, 2022 at the __________________, in accordance with the
2004 Rules of Notarial Practice, affiant ____________________________ exhibiting
to me his/her ________________________________ issued by the
_______________________, a competent proof of identity, and known to me and to
me known personally to be the same person who executed the foregoing special
power of attorney.

WITNESS my hand and seal on the date and in the place first above
written.

Doc. No. ______

Page No. ______ NOTARY PUBLIC
Book No. ______
Series of 2022