Power Of Attorney Form

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The Consular Section of the Philippine Embassy in Tokyo, Japan assumes no responsibility for the contents of this document
Notarial Form 2a/GPoA
POWER OF ATTORNEY
(Pagtatalaga ng Kapangyarihan Pangkinatawan)
KNOW ALL MEN BY THESE PRESENTS, that I:
IPINABABATID SA LAHAT NA SA PAMAMAGITAN NITO, ako, si:
_________________________________________________________, Filipino citizen, of sound mind,
born on
_____________________
in
_________________________
on this date aged
_______
years,
presently residing at
_________________________________________________________________
do hereby name, appoint and constitute:
ay aking hinihirang at itinatalaga si:
Name:____________________________________________ Citizenship ____________________
Date of Birth:______________________ Place of Birth:___________________________________
Residence:_______________________________________________________________________
to be my true and lawful ATTORNEY-IN-FACT, for me and in my name, place and stead,
bilang aking tunay at ligal na tagapangasiwa’t kinatawan, na para sa akin, sa ganang akin, at sa aking pangalan
to do and perform the following act(s) and deed(s):
ay gagawin at isasakatuparan ang mga sumusunod:
[ Use the reverse side as additional space when necessary / Gamitin ang likod ng papel kung kinakailangan ]
HEREBY GIVING AND GRANTING unto said ATTORNEY-IN-FACT full power and authority requisite or
NGAYO’Y IBINIBIGAY AT PINAHIHINTULOT sa nabanggit na kinatawan, ang lahat ng kapangyarihan na kinakailangan
necessary, to perform or cause the necessary act(s) to be done, fully and completely as I might or could lawfully
upang gawin, ipagawa, o maisakatuparan ang lahat na siyang ipinagagawa, ng wasto at buong husay, na siyang maaari kong magawa
do if I were personally present; and
at gagawin ng sarili kung siyang naririyan; at
HEREBY RATIFYING AND CONFIRMING all that my ATTORNEY-IN-FACT shall lawfully do or cause to be done,
NGAYO’Y TINITIYAK at PINAGTITIBAY ang lahat ng gagawin o isasagawa ng aking kinatawan, sa bisa ng pagtatalaga
under these presents.
na napapaloob sa kasulatang ito.
IN WITNESS WHEREOF, I have hereunto affixed my signature this_______________________, in Tokyo, Japan.
Bilang patunay sa lahat ng ito, ako ay lumalagda dito, ngayong ika-
, sa Tokyo, Japan.
Signed in the presence
of:/Nilagdaan,saksi sina:
_______________________________
Witness 1:______________________________________
Signature of Principal/
Lagda ng Nagbibigay-Kapangyarihan
Signature:______________________________
Identification Document No:____________________________
Witness 2:______________________________________
Expiration Date:______________________________________
Signature:______________________________
Issuing Authority:_____________________________________

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