I, _______________, single, of legal age, with residence and postal address at _____________________, do hereby APPOINT ______________________, single, likewise of legal age and postal address as our true and legal representative to act for and in my name and to perform the following acts: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ HEREBY GRANTING unto my representative full power and authority to execute and perform every act necessary to render effectively as though I myself, have so performed it, and HEREBY APPROVING ALL that she may do by virtue hereof. IN WITNESS WHEREOF, WE HAVE HEREUNTO SET OUR HANDS THIS ____DAY OF _________, AT Manila.