REPUBLIC OF THE PHILIPPINES )

) S.S.
QUEZON CITY )

SPECIAL POWER OF ATTORNEY

I, _________________, of legal age, single, and presently residing at

__________________--, do hereby constitute and appoint my _________,
__________________, of legal age, Filipino and resident of ____________________-, to be my
true and lawful Attorney-in-fact, for me and in my name, place and stead, to do and execute the
following acts and things, to wit:

1. To
2.

HEREBY GIVING AND GRANTING UNTO my said Attorney-in-Fact full power and
authority whatsoever requisite, necessary or proper to be done in or about the premises, 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 shall do or cause to be done under and by
virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ of (Month) in the
year _____ in Quezon City.

________________________
Principal

___________________
Attorney-in-fact
 ACKNOWLEGEMENT

REPUBLIC OF THE PHILIPPINES )

) S.S.
QUEZON CITY )

On (Month) (Day), (Year) before me, ________________________, a Notary Public,

personally appeared (Name of Principal) exhibited to me her/his Government Social Security
System I.D. with _____________________issued at Quezon City who proved to me on the basis
of satisfactory evidence to be the person whose name is subscribed to the within instrument and
acknowledged to me that he executed the same in his/her authorized capacity, and that by his
signature on the instrument the person, or the entity upon behalf of which the person acted,
executed the foregoing instrument.

WITNESS my hand and official seal at this place of Quezon City on the (Day) of
(Month) (Year).

ATTY. ______________________________
Notary public for ____________________
___________________________________
IBP no. ____________
PTR no. ____________
Roll no. ____________
MCLE no. __________
Serial no. of commission: ___________

Doc. No. __________

Page no. __________
Book no. __________
Series of 2022