SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ___________, Filipino citizen, of legal age, with postal address at

________________________ after having been duly sworn to in accordance with law, do
hereby name, appoint and constitute and by this presents ______(representative),
Filipino citizen, of legal age, with postal address at ___________(address), 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 deeds:

1. To present and submit all documents in connection with BPI MS

Insurance Corporation for the processing of the claim for payment of Car
Insurance Benefits that I have with them;

2. To claim, collect and receive on my behalf, the abovesaid payment of Car

Insurance Benefits and others that I am entitled of receiving relative to
said Insurance; and

3. To sign all documentary requirements necessary and relative thereto.

GIVING AND GRANTING unto the said ATTORNEY-IN-FACT full power and
authority to do and perform all and every act and deed whatsoever requisite and
necessary to be done in and about the premises, as fully as to all intents and
purposes as I may could lawfully do if personally present with all the power of
substitution or revocation and hereby RATIFYING and CONFIRMING all that my
ATTORNEY-IN-FACT or his substitute can lawfully do or cause to be done by virtue
thereof.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

______________ day of _________________.

______________________________
Principal

__________________________________
Attorney-in-Fact

Signed in the presence of:

_________________________________ _______________________________

Republic of the Philippines )

_________________________) S.S
BEFORE ME, personally appeared:

Name Government Issued Date/Place Issued

Identification Number
_______________________
_______________________

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.

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

Notary Public

Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.