Special Power Of Attorney Page 2
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2Printed Name and Signature of
Printed Name and Signature of
Policyholder/Beneficiary
Policyholder/Beneficiary
Address
Address
Landline
Landline
Cellphone
Cellphone
Email address
Email address
Conforme:
______________________________________
Name and signature of the Attorney-in-Fact
Address
Landline
Cellphone
Email address
SIGNED IN THE PRESENCE OF:
SIGNED IN THE PRESENCE OF:
SIGNED IN THE PRESENCE OF:
SIGNED IN THE PRESENCE OF:
___________________________________
_______________________________________
Address
Address
Landline
Landline
Cellphone
Cellphone
Email address
Email address
[T [T [T [This document must be notarized]
his document must be notarized]
his document must be notarized]
his document must be notarized]
[I [I [I [If principal is abroad, this document must be authenti
f principal is abroad, this document must be authenticated at the nearest Philippine
cated at the nearest Philippine Consular Office]
Consular Office]
f principal is abroad, this document must be authenti
f principal is abroad, this document must be authenti
cated at the nearest Philippine
cated at the nearest Philippine
Consular Office]
Consular Office]
Note: Any check to be issued will be payable to the principal and not to the attorney in
fact and the check shall be for deposit only.
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Parent category: Legal