|SAMPLE LEGAL FORM||SPECIAL POWER OF ATTORNEY|
SPECIAL POWER OF ATTORNEY
WE, (Insert Name of Principal) single/married (insert name of spouse if married), of legal age, with residence and postal address at (Address) do hereby APPOINT (Insert name of Agent /Attorney-In-Fact)) single/married (insert name of spouse if married), likewise of legal age, with postal address at (Address) as our true and legal representative to act for and in our name and stead and to perform the following acts:
IN WITNESS WHEREOF , WE HAVE HEREUNTO SET OUR HANDS THIS ____ DAY OF _______________ 20__, AT (Insert Place of execution of this Instrument).
(Name of Principal) (Name of Agent /Attorney-In-Fact)
Signed in the presence of:
Republic of the Philippines )
Name CTC Number Date/Place Issued
Known to me and to me known to be the same persons who executed the foregoing instrument and acknowledged to me that the same is their free and voluntary act and deed.