HSAC Case Form No.

04

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I/We, _____________________________,
ALMA MIRADOR DALEY of legal age, ____________,
MARRIED with
residence at _____________________________,
CARAYCAYON, TIGAON, CAMARINES SUR do hereby appoint, name, and
constitute, _________________________,
WILLIAM RANDOLPH DALEY likewise of legal age, ----------
single/ married,
with residence at ____________________________________, as my/our
CARAYCAYON, TIGAON, CAMARINES SUR
true legal representative to do and perform the following acts and deeds:

1. To file and institute the Complaint/Answer for and in my/our name,

place and stead, and to execute such other papers to give full effect
to the said Complaint/Answer, including the Verification and
Certification Against Forum Shopping;

2. To act for and in my/our name, place and stead and to represent
me/us during the Mandatory Conference with full authority to enter
into amicable settlement under such terms and conditions as may be
acceptable to him/her, to submit to alternative modes of dispute
resolution and to make admissions or stipulations of facts and
documents without further consultation from me/us; and

3. To file an appeal or any other petition to protect my/our interests

and likewise with full power and authority to do and execute such
deeds, documents and things as may be proper and necessary to
advance the said interest.

I/We hereby grant my/our representative full power and authority to execute and
perform every act necessary to render effective the powers herein provided as though
I/we myself/ourselves have so performed it and hereby approving all that he/she may
do by virtue of this presents.

IN WITNESS WHEREOF, I/we hereunto set my/our hand this_____ day of

___________, 20_____, at ________________.

ALMA MIRADOR DALEY WILLIAM RANDOLPH DALEY

Complainant(s)/Respondent(s) Representative

Witness Witness
REPUBLIC OF THE PHILIPPINES)
________________________ ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in,

_______________________________, Philippines, personally appeared
_________________________,
Alma Mirador Daley with _____________________________
Philippine Identification card no.4315-0389-5182-6107
issued at Bulalacao,
______________________
Presentation, Camarines Sur on _______________________,
20 September 2021
known to me and to me known to be the same person(s) who executed the foregoing
Special Power of Attorney and he/she/they acknowledged to me that the same is
his/her/their voluntary act and deed.

This document is a Special Power of Attorney consisting of two (2) pages including this
page on which this Acknowledgement is written.

IN WITNESS WHEREOF, I have affixed my signature and seal on the date and place
first above written.

Doc. No. _____; Notary Public

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

SPA TO FILE CASE OR ANSWER || Page 2