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(single / married / widow), and a resident of _____________, Philippines, did on __date__ execute a SPECIAL POWER OF ATTORNEY, which I acknowledged before Notary Public _____________ and was recorded as Doc. No. _______; Page No _______; Book No. _______; Series of _______ of his Notarial Register, and there did appoint __Attorney-in-Fact__ as my true and lawful Attorney-in-Fact, for me and in my name to perform the acts therein set forth. That I do hereby REVOKE, ANNUL, and RECALL the said power of attorney, and do hereby revoke, recall, and annul all powers and authorities thereby given to the said __Attorney-in-Fact__ together with any and all concomitant rights, powers and privileges given to him. IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.
PRINCIPAL
(ACKNOWLEDGMENT)