SPECIAL POWER OF ATTORNEY

I, (COMPLETE NAME OF OWNER OF DOCUMENT), of legal age, (CIVIL STATUS) with address at
(COMPLETE ADDRESS) do hereby authorize Alfonso S. Francisco III, married, Filipino with residence
address at 2314 Malaya St., Balut, Tondo, Manila as my true and legal representative in my name, and stead to
do and perform acts, to wit:

1. To request Apostille of my (NAME OF DOCUMENT) at the Department of Foreign Affairs

2. To do all other matters concerning to the release of my document request;
3. To send the completed documents to my residence.

HEREBY GIVING AND GRANTING unto my attorney-in-fact full power and authority, to do and
perform all acts and things whatsoever requisite and necessary to be done in and about the premises as fully to
all intents and purposes as I might or could lawfully do or cause to be done by virtue thereof,

IN WITNESS WHEREOF, the parties hereby sign this Special Power of Attorney this __________at the
City of ____________

(COMPLETE NAME OF OWNER OF DOCUMENT)

Principal

Witnesses: ___________________________ __________________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

City of _____________ ) S.S.

On this ____________, 2022 in the City of ____________, personally appeared before me the PARTIES,
who executed the foregoing SPECIAL POWER OF ATTORNEY and they acknowledged to me that the same is
their free will and voluntary act and deed.

WITNESS MY HAND and official SEAL at the place and on the date first above written.

Doc No. _____________

Page No. ____________

Book No. ____________

Series of 2022