Annex “C”
Republic of the Philippines
Office of the President
NATIONAL COMMISSION OF SENIOR CITIZENS
4th Floor, AAP Tower, 683 Aurora Blvd, Mariana, 1117 Quezon City, Philippines
Official website: www.ncsc.gov.ph
SPECIAL POWER OF ATTORNEY
(FOR DECEASED BENEFICIARY)
KNOW ALL PERSONS BY THESE PRESENTS
WE, Name of Grantor/Principal , with residence and postal address at Address, and Name of Name of
Grantor/Principal), with residence and postal address at Address, all Filipinos, of legal ages, hereby state that
we are the nearest living relative of Name of Deceased Octogenarian/Nonagenarian/Centenarian, a
beneficiary of Republic Act No. 11982, who died on Date of death and we hereby appoint Name of
Representative as our true and legal representative to act for and in our name and stead and to receive the
Cash Gift amounting to Amount in Words and Figures and Letter of Felicitation (if applicable) for Name of
Deceased Octogenarian/Nonagenarian/Centenarian.
HEREBY GRANTING unto our representative full power and authority to execute and perform every act
necessary to render effective the power granted to him/her, as though we ourselves, have so performed it,
and HEREBY APPROVING ALL that he may do by virtue hereof with full right of substitution of his person and
revocation of this instrument.
IN WITNESS WHEREOF, we have hereunto set our hands this ______ day of _______________ 20____, at
____________________.
_________________________________ _________________________________
Name and Signature of Name of Grantor/Principal Name and Signature of Grantee/Agent
_________________________________
Name and Signature of Name of Grantor/Principal
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES
______________________ S.S.
BEFORE ME, a Notary Public for and in the above jurisdiction, this ____, day of ______________________
2024, personally appeared the following individuals:
Name Competent Evidence of Identity Date/Place Issued
____________________________ _________________________ _________________________
____________________________ _________________________ _________________________
____________________________ _________________________ _________________________
known to me to be the same persons who executed the foregoing Special Power of Attorney, consisting of one
(1) page, including the page where this Acknowledgement is written, acknowledged to me that the same are
their free and voluntary act and deed.
WITNESS MY HAND SEAL on the date and place above written.
Doc. No. ______;
Page No. ______; NOTARY PUBLIC
Book No. ______;
Series of 2024.
Annex “C”
Republic of the Philippines
Office of the President
NATIONAL COMMISSION OF SENIOR CITIZENS
4th Floor, AAP Tower, 683 Aurora Blvd, Mariana, 1117 Quezon City, Philippines
Official website: www.ncsc.gov.ph
SPECIAL POWER OF ATTORNEY
(FOR LIVING BENEFICIARY)
KNOW ALL PERSONS BY THESE PRESENTS
I, Name of Principal , age years old, Filipino, and with residence and postal address at Address, do hereby appoint,
name, and constitute Name of Attorney-in-Fact, of legal age, Filipino, and with residence and postal address at
Address, to be my true and lawful attorney-in-fact, for me and in my name, place, and stead, to do and perform all
or any of the following:
1. To transact, file, apply, process, and follow-up in my behalf the cash gift as provided under Republic Act
No. 11982;
2. To submit all necessary documents in relation to the processing of the said cash gift;
3. To sign, execute, and accomplish pertinent documents in order to give full effect to the foregoing authority;
and
4. To claim/receive the cash gift amounting to amount in words and figures and Letter of Felicitation (if
applicable).
HEREBY GIVING AND GRANTING unto my said attorney-in-fact, full power and authority to do and perform all and
every act and deed requisite or necessary to carry into effect the foregoing authority as fully for all intents and
purposes as I might or could lawfully do if personally present.
HEREBY RATIFYING AND CONFIRMING all that my said attorney-in-fact shall do or cause to be done by virtue of
this authority.
This special power of attorney shall be in effect -
☐ for ___________ month(s);
☐ until the completion of the object or purpose above-stated;
☐ until revoked.
IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of _______________ 20____, at
____________________.
_________________________________ _________________________________
Name and Signature of Principal Name and Signature of Attorney-in-Fact
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES
______________________ S.S.
BEFORE ME, a Notary Public for and in the above jurisdiction, this ____, day of ______________________ 2024,
personally appeared the following individuals:
Name Competent Evidence of Identity Date/Place Issued
____________________________ _________________________ _________________________
____________________________ _________________________ _________________________
____________________________ _________________________ _________________________
known to me to be the same persons who executed the foregoing Special Power of Attorney, consisting of one
(1) page, including the page where this Acknowledgement is written, acknowledged to me that the same are their
free and voluntary act and deed.
WITNESS MY HAND SEAL on the date and place above written.
Doc. No. ______;
Page No. ______; NOTARY PUBLIC
Book No. ______;
Series of 2024.
