SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THIS PRESENTS:
I, ___________________________, do hereby these present NAME, CONSTITUTE, and
APPOINT, __________________________, to be my true and lawful ATTORNEY-IN-FACT, for me
in my name, place and stead to do and perform the following acts and things, as follows:
1. To enter into transactions with the Philippine Statistics Authority (PSA) for the purpose of
securing my Certificate of live Birth and other pertinent documents;
2. To apply, sign & submit pertinent documents and pay the necessary fees as maybe required by
PSA for the purpose of securing the above-mentioned documents; and
3. To do such any other act or thing that may be required necessary or incidental to carry out
effectively any and all of the purposes for which this authority is given.
I HEREBY GIVE AND GRANT unto my said attorney-in-fact full power and authority to do and
perform any and every act, and thing whatsoever requisite and necessary to be done, as fully to all intents
and purposes as I might or could lawfully do if personally present and hereby ratifying and confirming all
that my said attorney-in-fact shall lawfully do or cause to be done by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto set my hands this _________ at
_________________________.
________________________
Principal
I.D._____________________
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
) S.S.
SUBSCRIBED AND SWORN to before me this ____ at ______________, personally appeared
the affiant, who presented to me his respective evidence of identity as above-stated, and known to me and
to me known to be the same persons who executed the foregoing document and who acknowledged to me
that the same is his free act and deed.
Doc. No. _____;
Page. No. _____;
Book No. _____;
Series of 2022.
