SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENT:

I, __________, of legal age, single, Filipino citizen, and with residence and postal
address at ________________________, do hereby name, constitute and appoint
_________________________ with residence address at ______________________
to be my true and lawful attorney-in-fact, for and in my name, place and stead, to do
and perform the following acts and things, to wit:
A To file a petition for correction of clerical or typographical error and
accomplish necessary forms required by the Office of the City Civil Registrar
in relation thereto.
B To represent, secure, process, obtain, apply, facilitate and/or receive certified
true copies of pertinent documents pertaining to the legal processes involved
in the correction of clerical or typographical error in my birth certificate.
C To pay any and all fees appertaining to the petition thus filed.

D To receive the resolution/decision of the City Civil Registrar on the petition.

E To delegate in whole or in part any or all powers and authorities herein

conferred by means of an instrument in writing in favor of any third person or
persons whom my said Attorney-in-Fact may select;

HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact, full power

and authority to do and perform any and every act and thing whatsoever requisite
necessary or proper to be done in and about the premises as fully to all intents and
purposes as I might do or could do if personally present and acting in person.
HEREBY RATIFYING AND CONFIRMING all that my said Attorney-in-Fact shall
lawfully do and cause under and by virtue of these presents.
IN WITNESS THEREOF, I have hereunto set my hands this ___ day of January
2015, _____________________, Philippines.

____________
PRINCIPAL
Government I.D. No. ___________
Issued on _____________________
Issued at ______________________

Conforme:

___________________________

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 ACKNOWLEDGMENT

Republic of the Philippines]

___________ } s.s

BEFORE ME, a Notary Public, Personally appeared ________________ with the

above-mentioned Government I.D., known to me and to me known to be the same person who
executed this SPECIAL POWER OF ATTORNEY and she acknowledged to me that the same is
her free act and deed.

This instrument consisting of two (2) pages, including this page whereon this
acknowledgment is written, duly signed and its instrumental witnesses on each and every page
hereof relates to SPECIAL POWER OF ATTORNEY.

WITNESS MY HAND AND SEAL on this ___ day of ___________ at ______________,

Philippines.

Doc. No. ______

Page No. ______ Notary Public
Book No. _______
Series of 2015.

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