SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

THAT I, ___________ of legal age, married, Filipino and a resident of Brgy. Mandalagan,
Bacolod City, Negros Occidental, hereby make, constitute and appoint ________, a Filipino
citizen, of legal age, married, with office address at ______________, to be my true and lawful
attorney to act in my name and on my behalf and execute any or all of the following acts,
deeds, and things, to wit:

1. To represent me before the )________________ during the hearing of my

________________);

2. To sign, submit and receive any documents relative to the hearing of the said petition;

3. To do all other acts and deeds in furtherance of the foregoing authority;

HEREBY GIVING AND GRANTING unto my said attorney full power and authority
whatsoever requisite or proper to be done in or about the premises, as fully to all intents and
purposes as I might or could lawfully do if personally present, and hereby certifying and
confirming all that my said attorney shall do or cause to be done under and by virtue of these
presents.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day

of ______________, 2023 at the City of Bacolod.

____________
Principal
Conforme:

_______________
Attorney-in-fact

Signed in the presence of:

____________________________ __________________________

Acknowledged before me, this _____ day of _________________, 2023, at Bacolod City,
Philippines.

Doc No. _______

Page No. _______
Book No. _______
Series of 2023.