SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _____________________________, ____________, of legal age and a resident of

____________________________________________________ do by these presents hereby
CONSTITUTE AND APPOINT ___________________________ represented by
__________________________________________________________ to be my true and
lawful Attorneys-in-Fact to represent me before the various local and national government
agencies, political subdivisions, and organizations to secure and file all the necessary clearances
and certifications for the Renewal of my SIRV and dependents.

HEREBY GIVING AND GRANTING unto my said Attorneys-in-Fact full powers and
authority to do and perform all and every act requisite or necessary to carry into effect the
foregoing authority, including full authority to sign, execute, deliver and claim documents,
agreements and other writings of whatsoever nature, kind and description and other legal papers
pertaining thereto, as fully to all intents and purposes as I might or could lawfully do if
personally present, and hereby ratifying and confirming all that our said Attorneys-in-Fact shall
lawfully do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hands this ___________ day of

_____________ 2020 in ___________________City, Philippines.

_______________
Principal

Signed in the presence of:

___________________________________ ___________________________________

ACKNOWLEDGMENT

Republic of the Philippines)

________________City ) S.S.
x-----------------------------------/

BEFORE ME, a Notary Public for and in the City of _________________, Philippines,
this ___________________, personally appeared with _________________No. ____ issued at
______________________ and expiring on _______ known to me and to me known to be the
same person who executed the foregoing instrument, acknowledged to me to be her free and
voluntary act and deed, consisting only of 1 page, including this Acknowledgment is written,
duly signed by her and her instrumental witnesses.

IN WITNESS WHEREOF, I have hereunto set my hand and seal this _____day of
_______________ 2020 in _____________________________, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.