SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, ________________________________of legal age, single, with postal address

at_________________________________________________, hereby APPOINT
Ms._________________________________, likewise of legal age, single and with
postal address at___________________________________________, as my true and
legal representative to act for and in my name and stead and to perform the following
acts:

1. To request, apply for, and claim any documents on my behalf from

the___________________________________________;

2. To request that documents in my name (i.e., school records, transcript, diploma)

be authenticated and certified as genuine by said agencies;

3. To apply for the RED RIBBON of my____________________________;

4. To pay the necessary fees related with the transactions stated above;

5. To claim said documents upon completion of the transactions.

HEREBY GIVING AND GRANTING unto my said attorney-in-fact full powers and
authority to do and perform all and every act requisite or necessary to carry into effect
the foregoing powers, as fully to all intents and purposes as I might or could lawfully do
if personally present, with full power of substitution and revocation, and hereby ratifying
and confirming all that my said attorney shall lawfully do or cause to be done by virtue
hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of 2017, in
____________________.

_________________________ ________________________
NAME NAME
Principal Attorney-in-fact

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

X , X ) S.S

BEFORE ME, a NOTARY PUBLIC, for and in the CITY OF ____________, this
________ day of __________, 2017, personally appeared the above-named persons, who have
satisfactorily proven to me their identities through identifying documents written below their
respective names and signatures, that they are the same persons who executed and voluntarily
signed the foregoing SPECIAL POWER OF ATTORNEY.

WITNESS MY HAND AND NOTARIAL SEAL, the ________ day of ________, 2017, in
the City of _______________.

_____________________________
NOTARY PUBLIC

Doc. No. __________________________;

Page No. _______________________;
Book No. _______________________;
Series No. ______________________;