SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

We, __________________, both of legal ages, Filipinos, married and residents of

________________________, Philippines, do hereby name, constitute and appoint
___________________, likewise of legal age, Filipino, single and a resident of
___________________, Philippines, to be my true and lawful attorney-in-fact to act, for and in
my stead, to do and perform the following acts, deeds and things, to wit:

1. To enter into transactions with the Philippine Statistics Authority (PSA) for the
purpose of securing our Marriage Certificate, our respective Certificates of Live
Birth, _________________________ and other pertinent documents;

2. To apply, sign & submit pertinent documents and pay the necessary fees as
maybe required by PSA for the purpose of securing the above-mentioned
documents; and

3. To do such any other act or thing that may be required necessary or incidental
to carry out effectively any and all of the purposes for which this authority is
given.

I HEREBY GIVE AND GRANT unto my said attorney-in-fact full power and authority to
do and perform any and every act, and thing whatsoever requisite and necessary to be done, as
fully to all intents and purposes as I might or could lawfully 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 of these presents.

IN WITNESS WHEREOF, We have hereunto set our hands this _______________ at

_______________________.

______________________ _____________________
Principal Principal
I.D. _________________ I.D. ________________

Signed in the presence of:

_______________________ and _______________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

City of Tacloban ) S.S.

BEFORE ME, this ______________ in _________________, personally appeared the

affiants, who presented to me their respective evidence of identity as above-stated, and known to
me and to me known to be the same persons who executed the foregoing document and who
acknowledged to me that the same is their free act and deed.

Doc. No. _____;

Page No. _____;
Book No._____;
Series of 2019.