SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, <FIRST NAME+MI+SURNAME> , of legal <<Citizenship>> and a

age,

resident at <<< Principal’s Address>>> , do hereby name,

appoint & constitute <FIRST NAME+MI+SURNAME > , of legal age, and a resident

at <<<Agent’s Address>>> , to be my true and lawful

Attorney-in-Fact, for me and in my name, place and stead to the following acts:

1. To claim any amount of money, whether cash or in check, payable to me by or

from <<Name of Payor>> ;

2. To sign a document to acknowledge receipt of the said amount;

3. To sign a quitclaim or any document releasing the said payor from any
obligation or liability to me;

4. To receive or claim any and all documents in relation to or arising from my

transaction or contract with the payor;

5. To sign any and all documents as may be necessary for the above-stated
purpose/s.

HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact full power

and authority to do and perform all and every act requisite or necessary to carry into effect

the foregoing authority to sell, as fully to all intents and purposes as I might or could

lawfully do if personally present, with full power of substitution and revocation, and hereby

ratifying and confirming all that any of my said attorney-in-fact or his substitutes shall

lawfully do or cause to be done by virtue hereof.

SIGNED this day, Pick Date. at <City or Mun.> , Philippines.

OWNER’S SIGNATURE ABOVE PRINTED NAME

Conforme:

AGENT’S SIGNATURE ABOVE PRINTED NAME

Witnessed by:

[NOTARIAL ACKNOWLEDGMENT ON SEPARATE PAGE]

SIGNATURE ABOVE PRINTED NAME SIGNATURE ABOVE PRINTED NAME

[NOTARIAL ACKNOWLEDGMENT ON SEPARATE PAGE]