REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF _____________) S. S.
MARINDUQUE PROVINCE )

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

WE, _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________,
of legal age, with residence address at _________________________________________
________________________________________________________, do hereby
APPOINT, NAME AND CONSTITUTE ____________________________________,
with residence at __________________________________________, to be my true and
lawful Attorney-in-Fact, to act, for and in my stead, to do and perform the following acts,
deeds, and things in relation to a parcel of land situated at
__________________________ _________________________________,
MARINDUQUE, covered by _____________ ___________________________, Lot No.
__________________, to wit:

1. To represent us and in our behalves in the processing of

documents for the parcelization of the subject land under ______________
____________________________, Lot No. _______ in our names under the SPLIT
Project Program of the Department of Agrarian Reform (DAR) and other
concerned agencies of the Government of the Republic of the Philippines;

2. To represent, execute, pay the fees required, sign any and

all documents and papers as well as claim/receive for and in our behalves
said documents from the concerned agencies or offices in the Philippines,
as well as to do any and all acts in order to accomplish the aforestated acts
and deeds;

3. To request, claim and receive the copy of the documents or

the parcelization of the subject land under __________________________, Lot
No._____________; and

4. To do all acts necessary to give effect to the foregoing

authority.

HEREBY GIVING AND GRANTING unto our said attorney-in-fact full power
and authority to do and perform any and every act, and thing whatsoever requisite and
necessary to be done in and about the premises, as fully to all intents and purposes as we
might or could lawfully do if personally present and hereby ratifying and confirming all
that our said attorney-in-fact shall lawfully do or cause to be done by virtue of these
presents.

IN WITNESS WHEREOF, WE have hereunto affixed our signatures this

____________________ at ____________________.

_____________________ _____________________

1
 Principal/Grantor Principal/Grantor

_____________________ _____________________

Principal/Grantor Principal/Grantor

_____________________________
Agent/Grantee

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF _____________) S. S.
MARINDUQUE PROVINCE )

BEFORE ME, a Notary Public for and in the ABOVE JURISDICTION, this
____________________ personally appeared _____________________________________
__________________________________________________________________
exhibiting their Valid ID, as follows:

Name I.D. Issued at Valid Until

known to me and to me known to be the same person who executed the foregoing SPECIAL
POWER OF ATTORNEY consisting of two (2) pages, including the page where the
acknowledgement is written, and affirmed to me that the same as his/her/their free and
voluntary act and deed.

WITNESS MY HAND AND NOTARIAL SEAL on the date and at the place first
written.

NOTARY PUBLIC
Doc. No. _______;
Page No. _______;
Book No. ______;
Series of 2022.