SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ___________________, Owner / General Manager of ___________________ of legal age,

Filipino, with business address at _______________________, has made, constituted and appointed, and
does by these presents make, constitute and appoint _____________, with postal address at
_______________________, as my true and lawful attorney-in-fact, for me and in my name, place, and
stead, to do and perform the following acts:

1. To process my application for my BIR Form 2303, Authority to Print of my Billing

Statement and Official Receipts; and
2. To do all related and necessary acts consistent and to give full effect to
the above-described power of attorney.

GIVING AND GRANTING unto said attorney-in-fact full power and authority to do and perform
all and every act and thing whatsoever, requisite and necessary or proper to be done in and about the
premises, as fully to all intents and purposes as I might or could do if personally present and acting in
person, with full power of substitution or revocation, and hereby ratifying and confirming all that my said
attorney or his substitute shall lawfully do or cause to be done by virtue of these presents.

IN WITNESS WHEREOF, I have hereunder set my hand this _____ day of _______________,
_____ at _______________.

_________________________
GRANTOR

__________________________
GRANTEE

BEFORE ME, a Notary Public for and in _______________, this ___ day of _____________,
_____, personally appeared herein GRANTOR, exhibiting her _________________ issued on __________
at _____________, known to me and to me known to be the same person who executed this Special Power
of Attorney, expressing to me that the same was his free and voluntary act and deed.

WITNESS MY HAND AND SEAL in the date and place first above-written.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of _______.