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I, _______________, of legal age, Filipino, single, and with Philippine

residence address at __________________________, have made, constituted,
and appointed _______________________________ with residence address at
____________________________, to be my true and lawful attorney-in-fact, for
me and in my name, place and stead, to perform the following acts, to wit:

1. To represent me as Petitioner in the pending Petition for

___________________________ and to represent me in all
trial hearings and all other stages of the said case as well as
in the:

a. Submission to alternative modes of dispute resolution;

b. The necessity or desirability of amendments to the
c. The possibility of obtaining stipulations or admissions of
facts and of documents to avoid unnecessary proof;
d. The limitation of the numbers of witnesses; and
e. To sign and interpose appeal, petition for certiorari or appeal
memorandum whenever necessary;

2. To attend pre-trial conference and perform all the provisions

mandated under Rule 18 of 1997 Rules of Civil Procedure, in
connection with and related to my aforesaid action/petition,
with full authority to delegate this power to another person or
attorney who will attend to the case; and

3. Such other matters as may aid the prompt disposition of the


HEREBY GIVING AND GRANTING unto my said attorney-in-fact full

power and authority to do and perform all and every act and thing whatsoever
requisite and necessary to be done in and about the premises, as fully, to all
intents and purposes, as I might or could do if personally present and hereby
ratifying and confirming all that my said attorney-in-fact shall lawfully do or cause
to be done by virtue thereof.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

January 2017.



CITY OF ________ ) SS.

BEFORE ME, a notary public for and in the above jurisdiction personally
appeared ____________________ with passport number ______ issued
_________ known to me and to be known to be the same person who executed
the foregoing instrument which he acknowledged to be his free act and deed.

This Special Power of Attorney consisting of two (2) pages including the
page on which this acknowledgment appears has been signed by the party/ies
and his witnesses

WITNESS MY HAND AND SEAL on this _____ day of December 2017 at

Makati City, Philippines.

Doc. No _______ ;
Page No.______ NOTARY PUBLIC
Book No.______ ,
Series of 2017.