Legal Form: Special Power of Attorney

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

THAT I, _____________________, of legal age, Filipino, (single/married), a resident of _______, Philippines, do hereby name, constitute, and appoint X, of legal age, Filipino, (single/married), a resident of ____________, Philippines, as my attorney-in-fact for me and in my name, place and stead and for my own use and benefit, to do and perform the following acts, to wit:

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Affidavit of Loss

Republic of the Philippines )
City of ___________________ ) S.S.

AFFIDAVIT OF LOSS

I, ________, of legal age, single, Filipino and resident of ___________, Philippines, after having been duly sworn in accordance with law, do hereby depose and say:

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