Republic of the Philippines )

City of __________ ) S.c.

SPECIAL POWER OF ATTORNEY

I, JUAN AAAA, hereby name, appoint and constitute XXXXX, to be my true and
lawful attorney, to act on my behalf and in my name, to execute and perform all or any of
the following acts and deeds in the Department of Foreign Affairs (DFA) Regional Office,
_________ City, to wit:

1. To sign and claim the Philippine passports (renewal) of my children, namely:

a. JUAN AAAA JR.

b. MARIA AAAA

2. To perform such other acts consistent with the authority herein granted.

HEREBY GIVING AND GRANTING unto our 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 we
were personally present, with full power of substitution and revocation, and hereby
ratifying and confirming all that our said attorney-in-fact or her substitute shall lawfully
do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of

____________, _____ in _________________.

JUAN AAAA

Affiant

Conforme:

XXXXX

Signed in the presence of:

_________________________ ________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

Province of __________ ) SS.
____________ )

BEFORE ME, a Notary Public for and in the ___________, this _____________ ,
personally appeared:

Name Competent evidence of identity

____________________________ __________________________________________

Known to me and to me known to be the same person who executed the foregoing
Special Power of Attorney and acknowledged to me that the same are his free act and
voluntary act and deed.

This instrument, consisting of one (1) page, including the page on which this
acknowledgment is written, has been signed thereof by the concerned parties and their
witnesses, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL this _____________ at _______________, Philippines.

Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 20__.