SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That I/WE, ___________________________________, Filipino citizen/s of legal age, single/married with
residence and postal address at _________________________________________________ do hereby name,
constitute, and appoint _____________________________________________, of legal age, single/married, with
residence and postal address at ____________________________________________ to be my/our true and lawful
Attorney-in-Fact for me/us in my/our name, place and stead, to do my/our all of the following acts, to wit:
1. To file and refund the customer deposit under his/her name on the account of
_________________________________;
2. To make, sign and execute, for and in my/our behalf, any documents which may be necessary
for the approval of the application and release of check;
3. To receive the check due me/us from ____________________________________.
HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact full power and authority to do and perform
any and every act requisite and necessary to be done in and about the premises as fully to all intents and purposes
as I might or could do, I personally present and acting in person, HEREBY RATIFYING AND CONFIRMING all that
my said Attorney-in-Fact may also do or cause to be done under and by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of _________, 20___ at the
Province/City of ______________________________.
_____________________________ _____________________________
Attorney-in-Fact Principal
______________ No. ___________ ______________ No. ___________
Date of Issue __________________ Date of Issue __________________
Expiry Date ___________________ Expiry Date ___________________
With marital consent
_____________________________
SIGNED IN THE PRESENCE OF:
______________________________ _______________________________
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
PROVINCE/CITY OF ____________) S.S.
BEFORE ME, A Notary Public for and in the _______________________, Province of
_____________________, this ______ day of _____________, 20______, personally appeared the above-named
persons, who has satisfactorily proven to me their identity through their identifying documents written below their
name and signature, that they are the same person who executed and voluntarily signed the foregoing Special Power
of Attorney, which he/she acknowledged before me as his/her free and voluntary act and deed.
WITNESS MY HAND AND NOTARIAL SEAL.
NOTARY PUBLIC
Doc. No. _________;
Page No. ________;
Book No._________;
(February 2009)
Series of _________.
SPECIFICATIONS:
SPECIAL POWER OF ATTORNEY
FORM CODE : FPC014
SIZE: 8 ½ “ x 13”
MATERIAL : White bond paper, subs. 20
PROCESS : Offset, one side printing
COLOR : One color print, black
CONSTRUCTION : 100 sheets per pad
