Commission on Elections

October 30, 2023

Barangay and Sangguniang Kabataan Elections SPA

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________________ , who ran for the position of

___________________________________________________________________________
__________ in the 30 October 2023 Elections, do hereby name, constitute and appoint
_______________________ , of legal age and a resident of
_________________________________________ , to be my true and lawful attorney-in-fact
for me, and in my name, place and stead, to do and performing the following acts, to wit:

(1) To personally submit to the appropriate Office of the Election Officer my

Statement of Contributions and Expenditures and all its required
Schedules and supporting documents; and

(2) To receive any document or certificate in relation to the submission thereof;

This special power of attorney, however, does not constitute a grant of authority to my
attorney-in-fact to sign on my behalf the Statement of Contributions and Expenditures
(SOCE) and the relevant attachments, which is personal to me as a candidate and cannot be
delegated to anyone.

I further declare that any act or thing lawfully done hereunder and within powers
herein stated by my said attorney-in-fact shall be binding on myself.

IN WITNESS WHEREOF, I and my attorney-in-fact hereby set our hands this _____
day of ________, in the _________________________ .

(Signature over Printed Name of the (Signature over Printed Name of

Candidate) Representative-Agent)
PRINCIPAL ATTORNEY-IN-FACT

WITNESSES:

________________________________ _______________________________

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City/Municipality of ) S.S.

BEFORE ME, on the date and place above written, personally appeared the following
persons with competent evidence of their identity:

Name ID Document Expiry Issuing

Date Authority

Said persons acknowledged under oath to me under penalty of law, that the whole
contents of this document are true and the same are their free and voluntary acts and deeds.

WITNESS MY HAND AND NOTARIAL SEAL.

Notary Public
Doc. No. : _____
Page No.: _____
Book No.: _____
Series of 2023.