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REPUBLIC OF THE PHILIPPINES ))

)) S.S.

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _______________, of legal age, Filipino, Married, and a


resident of ___________________________, do hereby name,
constitute and appoint _________________________, to be my
true and lawful attorney-in-fact, for me and in my name, place and
stead, to do and perform the following acts deeds and things, to wit:

To represent us in the filing of the case for ________ entitled


______________________________ docketed as Case No.
_____________ before the _________________________.

That said attorney-in-fact is authorized to make representation


in our behalf in any courts of law or any quasi-judicial or
administrative bodies, or any government agencies, sign all papers
and documents, demand and receive any papers so that my interest
will be preserved, protected or maintained, but most specifically to
attend, represent me in the above-mentioned Criminal Case for
____________________ defined and penalized under
_________________________________.

That he is authorized to enter into stipulations, amicable


settlement and negotiate in my behalf or admissions of facts and of
documents during pre-trial, and in all phases or stages of a trial, as
the Rules of Court may provide and warrant in all cases that will be
filed by my attorney-in-fact.

And generally to do and perform all and every act and thing
which may be requisite, necessary or proper to carry out the above
purposes.

HEREBY GIVING AND GRANTING unto my said attorney-in-


fact full powers and authority to do and perform all and every act
requisite or necessary to carry into effect the foregoing authority, as
fully to all intents and purposes as I might or could lawfully do if
personally present, with full power of substitution and revocation, and
HEREBY RATIFYING and CONFIRMING all that my said attorney-in-
fact or her substitute shall lawfully do or cause to be done by virtue
hereof.
2

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


day of June, 2016 in ___________________, Philippines.

Principal Attorney-in-fact

SIGNED IN THE PRESENCE OF:

____________________ __________________

REPUBLIC OF THE PHILIPPINES)


) S.S.

BEFORE ME, a Notary Public, the ___ day of June, 2016, in


_________________, Philippines, personally appeared the parties,
all known to me to be the same persons who executed the foregoing
instrument, and they acknowledged before me with their two (2)
instrumental witnesses and that the same is their own voluntary act
and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and


affixed my notarial seal, the day, year and place above written.

DOC. NO. :
BOOK NO. :
PAGE NO. :
SERIES OF 2016.