Special Power Of Attorney Template Page 3

REPUBLIC OF THE PHILIPPINES) S.S.

CITY OF

)

At the above stated locality, on this _____________ day of ________________

_________________ before me personally appeared:

Name

Competence Evidence of Identity

Date & Place of Issue

made known to me to be the same person/s who executed the foregoing instrument and

acknowledge the same to his/their free act and deed. This instrument refers to a Special Power of

Attorney and consist of three (3) pages including this page wherein the acknowledgement is

written, signed by the party/parties and his/their witnesses and sealed with my notarial seal. The

party/parties exhibited to me his/ their residence certificate/s above mentioned.

NOTARY PUBLIC

Doc. No. ______

Page No. ______

Book No. ______

Series of ______

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