SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ____________________, of legal age, Filipino, Single, and a resident of

____________, Barangay Payatas, Quezon City, Philippines , do hereby name,
constitute and appoint ___________, of legal age, Filipino, married, and a resident
of Barangay ____________________, 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 and things,
to wit:.

1. To represent me before the Local Civil Registrar of Pandan, Catanduanes

in my application to change my name from _____________ to
_____________.
2. To submit documents and other data required in the application for change
of name; and
3. To do such other acts or matters which may aid in the prompt disposition
of the aforementioned application for change of name.

HEREBY GIVING AND GRANTING unto my said attorney-in-fact full

power and authority whatsoever requisite or necessary or proper to be done in and
about the premises as fully to all intents and purposes as I might or could lawfully
do if personally present, with power of substition and revocation, and hereby
ratifying and confirming that my said attorney-in-fact shall lawfully do or cause to
be done under and by virtue of these presents.

August 14, 2017.

_________________________
______________________
Principal

Conforme:

_____________________
dfwekjf
Attorney-in-Fact

Signed in the presence of:

1
 ______________________ _________________________

ACKNOWLEDGMENT

BEFORE ME, a Notary Public, personally appeared on this ___ day of August
2017 in Quezon City, Philippines;

Name: I.D Date/Place of Issue

1. _____
2. ________________

known to me and to me known to be the same persons who executed the foregoing
instrument and acknowldged that the same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and at the place first above
written.

____________________
NOTARY PUBLIC

Doc. No. ______

Book No. _____
Page No. ______
Series of 2017