SPECIAL POWER OF ATTORNEY

I, ______________________________________________________________, of legal age,

Filipino, and with address at ______________________________________
_______________________________________________________________________, after being
sworn in accordance with law, hereby state:

1. I am authorized / applying for authority to provide transportation services in the Philippines

as a Transportation Network Vehicle Service ("TNVS") under the regulations of the Land
Transportation Franchising and Regulatory Board ("LTFRB").

2. I intend to enter into an agreement or agreements ("Agreements") with Uber Systems, Inc.
("USI"), a Transportation Network Company duly accredited by the LTFRB and/or its
affiliates or related parties, including Uber Philippines B.V. (collectively referred to as
"Uber") for the purpose of accessing and using Uber's technology application and other
related services, being accredited as a TNVS, performing the activities or providing the
services of a TNVS, and of enhancing my transportation services.

3. For the purposes hereunder stated, I hereby name, constitute and appoint
___________________________________________________________

with address at:

___________________________________________________________
___________________________________________________________

to be my lawful attorney-in-fact, for and in my name, place and stead, to do and perform all
acts necessary or proper for me to become a TNVS and/or to be able to provide transportation
services using the Uber technology application, including (a) processing, sharing and
disclosing relevant personal information about me to Uber; (b) negotiating, transacting or
contracting with Uber, including the negotiation for / execution of the Agreements and
obtaining accreditation/good standing as a TNVS; (c) receiving any payments due to me
and/or making or authorizing payments due from me under the Agreements; (d) exercising all
my rights and performing all my obligations under the Agreements; and (e) pursuing, entering
into compromises or waiving any claims or causes of action I have against Uber or defending
any such claims or causes of action against me by Uber.

4. I, however, withhold from my attorney-in-fact the authority to receive summons on my behalf.

5. I hereby grant my attorney-in-fact full power and authority to do and perform any and all other
acts and things necessary and proper in connection with the implementation of the foregoing
authority, as fully to all intents and purposes as I might or could lawfully do if personally present.
I hereby ratify and confirm all that said attorneys-in-fact shall lawfully do or cause to be done or
shall have lawfully done or have caused to be done in accordance with the foregoing authority.

IN WITNESS WHEREOF, I have hereunto signed these presents on this ___ day of
_______________ 2015.

___________________________
Signature over print name

1
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

CITY OF _________ ) ss.

BEFORE ME, a Notary Public for and in the city named above, personally appeared:

Competent Evidence of Identity Community Tax Certificate

Type of ID ID Number and Number Date/Place
Expiry Date (if Issued
Affiant applicable)
1

executed this Special Power of Attorney, who made oath to the truth thereof, and he / she
acknowledged to me that the same was his / her free and voluntary act.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on the
date and at the place indicated above.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015.