SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I,
___________________________________________
legal
age,
single/married/widow, and with residence at___________________________________
____________________________________________________do hereby APPOINT,
NAME AND CONSTITUTE _____________________________________, likewise of
legal age, single/married/widow and with residence and postal address at
_______________________________________________________________ to be
my true and lawful attorney, for me and in my name, place and stead, to do and perform
the following acts, deeds and things to wit:

To ask, demand, collect and receive all sums of money either in cash or check(s)
payable or owing to me from______________________________________________.
To endorse and encash the aforementioned check(s), if any, with any banking
and financial institution duly authorized by the Banko Sentral ng Pilipinas;
To sign and execute any and all papers with all and any third persons, concerns
and entities in connection with the above-given powers; and
To do and perform for my behalf acts which are related to the above powers.

HEREBY GIVING AND GRANTING unto my said attorney full power and
authority to do whatsoever requisite or necessary or proper to be done in or about the
premises, as fully to all intents and purpose as I might or could lawfully do if personally
present, and hereby ratifying and confirming all that my said attorney shall do or cause
to be done under and by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto

_________________ at _________________, Canada.

set

my

hand

on

this

_______________________
(Affiant)

SIGNED IN THE PRESENCE OF :____________________ ___________________

At the Philippine Consulate General, Toronto, Ontario, Canada