SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

THAT I, ____________________, of legal age, Filipino, residing at

______________________________, have made, constituted, and
_______________________, also of legal age, Filipino with address at
_______________________________, as my true and lawful attorney in fact, for me
and in my name, place and stead, to perform the following acts:

1. To sign, execute, and/or deliver documents, papers, and forms with the
PHILIPPINE STATISTICS AUTHORITY (PSA) in obtaining documents such as
Marriage Certificate and Birth Certificate.

2. To sign, execute, and/or deliver documents, papers, and forms with the
PHILIPPINE STATISTICS AUTHORITY (PSA) in obtaining processing legal
documents for authentication (Apostilled Red Ribbon) to be used in abroad.

3. To do all such acts, deeds, matters and things as the Attorney in Fact may deem
fit, proper and necessary in respect of the Philippine Statistics Authority (PSA),
Department of Foreign Affairs (DFA) , and other government agencies and/or
incidental for the powers mentioned hereinabove or connected therewith.

HEREBY GIVING AND GRANTING unto my said attorney in fact full power and
authority to do and perform all and every act and thing whatsoever requisite and
necessary 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 hereby ratifying and confirming all that my
said attorney in fact shall lawfully do or cause to be done by virtue thereof.

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

of______________2023.

_____________________
NAME

Affiant

ACKNOWLEGMENT

REPUBLIC OF THE PHILIPPINES)

____________________________) SS.

BEFORE ME A NOTARY PUBLIC for and in the above jurisdiction personally

appeared with _______________________ issued on _____________________ to me
and to be known to be the same person who executed the foregoing instrument which
he acknowledged to be his free act and deed.

DOC. NO. _______ ;

PAGE NO.______ NOTARY PUBLIC
BOOK NO.______ ,
Series of 2023.