SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENT:

That I, (brother’s name) , Filipino, of legal age and presently residing at (brother’s
address) do hereby name, constitute and appoint my wife , (wife’s name) , and my brother
(full name mo) to be my true and lawful attorney-in-fact, for me and my name , place, and
stead, and for my own use and benefits, to do and perform all or any of the following and
things:

1. To apply, follow-up and claim either in partial or full and/or final payment of my back
pay from (employer’s name) and to receive the same ;
2. To sign and execute the necessary documents , agreements , and other legal papers
pertaining thereto;
3. To encash the said check with the depository bank.

GIVING AND GRANTING unto my said attorney-in-fact full power and authority to do and
perform and act and thing whatsoever requisite and necessary to be done in about the
premises , as fully to all intents and purposes as I might or could do if personally present,
HEREBY RATIFYING AND CONFIRMING all that my said attorney shall lawfully do or
cause to be done by virtue of these presents.

IN WITNESS WHEREOF , I have hereunto set my hand this ____ day of___________
20____ at City of ___________.

_________Name ni brother__________
PRINCIPAL

Conforme:

_______Name ni wife_________ ________Name mo________

Attorney –in-fact Attorney-in-fact

Sign in the presence of

_______________________ __________________________
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

( ) S.C.

BEFORE ME, a Notary Public in and for_________________, Philippines, this day

of_________________, personally appeared the following persons and presenting to me
competent evidence of identity:

Name Government Issued ID Date/Place Issued

1. Name ni Brother

2, Name ni wife
3. Name mo

known to me and to me known to be the same persons who executed the foregoing Special Power
of Attorney consisting of two (2) pages including this page upon which the acknowledgment is
written, and who acknowledged to me that their signatures on the document were voluntarily
affixed for the purpose stated in the document, and that the same executed the document is their
free and voluntary acts and deeds.

IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal on the
date and the place first herein above written.

Doc. No. _______

Page No. _______
Book No. ______
Series of 20_____