Republic of the Philippines )

________. . . . ) Sc.

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, __________, of legal age, Filipino, and presently residing at _______, after having been duly sworn in
accordance to law, do hereby name and appoint my daughter ________, with address at ___________, as
my Attorney-in-Fact, in my name, place and stead, to do and perform the following:

1. To represent and act on my behalf in an intended judicial action, pertaining to Original Certificate
of Title No. G-______ and Transfer Certificate of Title No. ________, and before the appropriate court
having jurisdiction, with authority to sign and execute pertinent documents for the filing of a proper
complaint/petition which my Attorneys-in-Fact is given special power, and to appear at the hearings,
including but not exclusive to the Mediation Proceedings, Pre-Trial and the Trial for the proper
resolution or settlement of my claims.

2. To settle, make admissions, compromise and arbitrate said legal claims and demands with a view
of amicably terminating the same if still legally feasible, to sign, execute and deliver on my behalf,
agreements, documents, receipts or any property in connection with any settlement or compromise
agreement.

3. To sign the pleadings and all other documents necessary thereof, and to submit all documentary
evidence necessary in pursuance of this authority.

4. To receive all notices and court processes in relation thereto.

HEREBY GIVING AND GRANTING unto the said attorney-in-fact full power and authority to do and
perform such acts to carry into effect the foregoing authority as fully to all intents and purposes as I could
lawfully do if personally present, and hereby confirming all that my said attorney-in-fact shall lawfully
do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of June 2017 in ___________.

_______ ________
Principal Attorney-in-Fact

Signed in the presence of:

_______________________________ _______________________________

ACKNOWLEDGMENT

BEFORE ME, this _____ day of June 2017 in the City of __________, Philippines, personally
appeared ________, issued by the Commission on Elections, known to me to be the same person who
executed this foregoing one-page instrument, and he acknowledged to me that the same is his own free
act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal, the day,
year, and place above written.

NOTARY PUBLIC
Doc. No. ____
Book No.____
Page No. ____
Series of 2017.