SPECIAL POWER OF ATTORNEY
I _______________________, hereby name, appoint and constitute _________________________
to be my true and lawful attorney, to act on my behalf and in my name, to execute and perform
all or any of the following acts, deeds, matters and things, in connection with
_________________________, to wit:
(ENUMERATE POWERS TO BE CONFERRED)
HEREBY GIVING AND GRANTING unto our said attorney full powers and authority to do and perform
all and every act requisite or necessary to carry into effect the foregoing powers, as fully to all
intents and purposes as I might or could lawfully do if personally present, with full power of
substitution and revocation, and hereby ratifying and confirming all that my said attorney or his
substitute shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _________ 2001, in
__________________.
____________________________
Conforme:
(Signature
of
Appointee)
Signed in the presence of:
__________________________
__________________________
ACKNOWLEDGMENT
REPUBLIC
MAKATI, METRO MANILA ) S.S.
OF
THE
PHILIPPINES)
BEFORE ME , a Notary Public for and in the __________, this ___________________, personally
appeared the following:
Name
CTC
No.
Place
Date
known to me and to me known to be the same person/s who executed the foregoing General
Power of Attorney consisting of __ pages including the page on which this Acknowledgment is
written, and who acknowledged to me that the same is their free and voluntary act and deed.
IN WITNESS WHEREOF, I have placed my hand and seal on the date and at the place first
above-written.
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Page
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