SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, (complete name) , American, with residence address at (address), do hereby name,

constitute and appoint MARK FRANCIS FUENTES and/or any members of CARPO LAW &
ASSOCIATES with office address at 8th Floor, Marajo Tower, 26th Street West corner 4th Avenue,
Bonifacio Global City, Taguig City, to be my true and lawful Attorney/s-in-Fact and in my name,
place, and stead, do or perform the following specific act(s):

1. To process, apply for, and secure a certified true copy of my Marriage Certificate or any
certificate showing the record of my marriage before the Philippine Statistics Office with the
following details:

Full Name, middle name, and surname of husband:

Full Name, middle name, and maiden surname of wife:
Place of marriage:
Date of marriage:

2. To procure such other documents pertaining to the application of the same;

3. To perform any and all acts and deeds as well as to execute, sign, deliver, submit, follow-up,
make payments for, and receive any and all documents and papers which are incidental,
necessary, and required for the immediate processing of the said Marriage Certificate; and

4. To receive a copy of said Marriage Certificate or any certificate showing the record of my
marriage.

HEREBY GIVING AND GRANTING unto said Attorney/s-in-Fact full power and
authority to do and perform every act necessary and required in connection with these presents and
hereby ratifying and confirming all the said attorney-in-fact/s shall lawfully do or cause to be done by
virtue of these presents.

IN WITNESS WHEREOF, I have hereunto affixed my signature on __ January 2020 at

Taguig City, Philippines.

(complete name)
Principal

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

) S.S.

SUBSCRIBED AND SWORN to before me, a Notary Public for and in Taguig City, this
__ January 2020 by with Passport No. ______________ known to me to be the same person who
executed the foregoing Special Power of Attorney and he acknowledged to me that the same is his
free act and deed.

WITNESS MY HAND AND SEAL on the date and place first above written.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.