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REPUBLIC OF THE PHILIPPINES )

CITY OF ILIGAN ) S.S.

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________, of legal age, single/married to

__________________, resident of _____________, do hereby name,
constitute, and appoint _____________, of legal age, single/married,
resident of _______________.

To be my true and lawful attorney-in-fact, for me and in my

name, place, and stead, to do and perform the special power to get
my ________________________, birth certificate at NSO-National
Statistics Office, ______________.

HEREBY GIVING AND GRANTING unto my said attorney full

powers and authority to do and perform all and every act requisite or
necessary to carry into effect the foregoing authority to sell, as fully
to all intents and purposes as I might or could lawfully do if
personally present, with full power of substitution and revocation,
hereby ratifying and confirming all that my said attorney or his
substitute shall lawfully do or cause to be done by virtue hereof.

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

day of _____, 2____, in ________ Philippines.

_________________________
Principal

WITNESSES
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__________________________ _________________________

BEFORE ME, this ___ day of _____, 2____ in the City of _____,
personally appeared:

Name Competent Evidence of Identity Place and Date of Issue

_____ ____________________________ ____________________

_____ ____________________________ ____________________

known to me to be the same person who executed the foregoing

instrument, and acknowledged that the same are their free act and
deed.

IN WITNESS WHEREOF, I have hereunto set my hand and

affixed my notarial seal on the date and place above written.

ATTY. YASIR M. ALI, Sh.L

NOTARY PUBLIC
Serial No. 18-197/Until December 31, 2019
PTR No. 8114887/For 2018
IBP Receipt No. 025985
MCLE Exempt/Admitted to the BAR on May 2017
Roll No. 66946

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of ______.