SPECIAL POWER OF ATTORNEY

AUTHORIZATION TO CLAIM CASH SURRENDER VALUE

(CHECK OR CASH) From Caritas Health Shield Inc.

KNOW ALL MEN BY THESE PRESENTS:

I, ____________________________, a Filipino, of legal age and resident of

__________________________________________Philippines, do hereby NAME,
CONSTITUTE, and APPOINT ___________________________, likewise a Filipino citizen,
of legal age, with residence and postal address ____________________________,
Philippines, to be my true and lawful attorney-in-fact for me and in my name, place
and stead to do any or all of the following acts and deeds, to wit:

1. Authorizing her to REPRESENT, REQUEST, CLAIM and RECEIVE the

corresponding CASH SURRENDER VALUE either in Cash or Check accruing
to me arising from the my Insurance Policy with Policy No.
_________________________;

2. Further authorizing her to make, sign, seal, execute and deliver any and all
documents and other writings upon terms and conditions as deemed
acceptable to my said attorney;

3. Finally, to perform all acts which is necessary and proper to attain the
foregoing.

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

and authority to do and perform any and all acts as may requisite or necessary to
carry into effect the foregoing authority as fully to all intents and purposes as I
might or could lawfully do as if I were personally present.

IN WITNESS WHEREOF, I have hereunto set my hand in this _____________,

at _______________________, Philippines.

By:

Principal - Grantor
CONFORME:

Grantee- Attorney-in-Fact
---------------------------------------------------------------------------------------------
(ACKNOWLEDGEMENT)

REPUBLIC OF THE PHILIPPINES }

CITY of Mandaue }S.S.
BEFORE ME, this __________________ ,at __________________, personally
appeared, affiant-principal with his competent evidence of identity who have made
himself known to me to be the same person who executed the foregoing instrument,
and acknowledged to me that the same is his own free and voluntary act and deed.
WITNESS MY HAND AND SEAL, on this ___________________, at the place
first above written.

Doc. No. ____;

Page No. ____;
Book No ._III_;
Series of 2019.