REPUBLIC OF THE PHILIPPINES)

_________________ ) S.S.ctcssss

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ____ , of legal age, Filipino, single/married and a resident of _________, do

hereby appoint, name, and constitute Mrs___________________, of legal age, Filipino, and a
resident of _________________________________, Philippines, to be my true and lawful
attorney-in-fact, for me, and in my name, place, stead, to do and perform the following acts and
things, to wit:
1. To be my full representative to appear in all government or private agencies for all
legal transactions on my behalf;
2. To transact, process, negotiate, follow-up, sign and receive documents from aforesaid
entities;
3. To make, execute and deliver contracts, documents, agreements, and other writings of
whatever nature or kind, with any of the offices/entities mentioned above and all third
persons, concerns, or entities, upon terms and conditions, which may be deemed
necessary for the purpose of the aforementioned, and acceptable to my said attorney-
in-fact may select;
4. To delegate in whole or in part any of the powers herein granted or conferred, by
means of an instrument in writing, in favor of any third person or persons whom my
attorney-in-fact may select;
5. To generally do or perform any act of deed necessary that may be required in
furtherance of this authority.

HEREBY GIVING AND GRANTING unto said attorney-in-fact full power and authority
make, sign, execute, and deliver any and all documents as may be necessary for the
implementation and furtherance of such power and authority as provided herein and to do and
perform all and every act requisite or necessary to carry into effect the foregoing authorities 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 my said
attorney-in-fact or his/her substitute shall lawfully do, have done, or cause to be done under and
by virtue hereof.

IN WITNESS WHEREOF, we have hereunto affixed our signature this __26th ____day
of MAY at __DUMAGUETE CITY___.

__________________________________
Affiant

__________________
Attorney-In-Fact
REPUBLIC OF THE PHILIPPINES)
_________________ ) S.S.

ACKNOWLEDGEMENT

BEFORE ME, A NOTARY PUBLIC, for and in _________________________ this ______

day of 2023 personally appeared known to be to be the same person who executed the foregoing
instrument and he/she further acknowledge to me that the same is his/her free and voluntary act,
and free will. This instrument refers to the Special Power of Attorney consisting of two pages
wherein the acknowledgement is also written.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Doc. No.:_____
Page No.:_____
Book No.:____
Series of 2023