SPECIAL POWER OF ATTORNEY

 KNOW ALL MEN BY THESE PRESENTS:

 
I, ______________________, widow, of legal age, with postal address at ______________, do
hereby APPOINT __________________, married, likewise of legal age, with postal address at
______________________________, as my true and legal representative to act for and in my name and stead
and to perform the following acts:

“To transact with the Office of Senior Citizens Affairs (OSCA)

and to receive for and on my behalf my senior citizen allowance and other
benefits due me.”

HEREBY GIVING AND GRANTING unto my representative full power and authority to
execute and perform every act or thing lawfully done hereunder and within powers herein stated
necessary to render effective the special power granted in this instrument, as though I myself has so
performed it, and HEREBY APPROVING and RATIFYING ALL that she may do by virtue thereof.
 
IN WITNESS WHEREOF, IHAVE HEREUNTO SET MY HAND THIS
____________________, at __________________.
 

 
_______________________
Principal

______________________
Attorney-In-Fact

Signed in the presence of:

________________________________    ______________________________

Republic of the Philippines )

__________________ ) S.S
 
BEFORE ME, personally appeared:
Name ID Number Date/Place Issued

                         

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

WITNESS MY HAND AND SEAL, on the date and place first above written.

                                                                                                              
Notary Public                     
 
Doc. No.______;
Page No. ______;
Book No.______;
Series of 2022.