SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _____________________, of legal age, with residence at _____________________, do hereby NAME, APPOINT and CONSTITUTE, _____________________, of legal age, Filipino, with office at _____________________, to be my true and lawful attorneys to act in, manage and conduct all my affairs, and for that purpose in my name and in my behalf to do and execute all of any of the following acts, deeds and things, to wit:

1. To receive and collect from the Social Security System any and

all sums of money/checks which I may claim as funeral benefits arising from the death of my husband, _____________________;

2. To represent, execute, pay the fees required, sign any and all document(s) and paper(s) as well as claim/receive for and in my behalf said document(s) from the Social Security System as well as to do any and all acts in order to accomplish the aforestated acts and deeds.

My attorney-in fact hereby accepts this appointment subject to its terms and agrees to act and perform in said fiduciary capacity consistent with my best interest as they in their best discretion deems advisable, and I affirm and ratify all acts so undertaken.

GIVING AND GRANTING unto said attorney-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises, hereby ratifying and confirming all that said attorney-in-fact shall lawfully do or cause to be done by virtue of these presents. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___day of August, 2013 at __________________________.

______________________________ Principal

With my conformity:

_____________________Attorney-in-fact

Signed in the presence of:

______________________________ _________________________

2

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)________________________ )S.S.

BEFORE ME, a Notary Public for and in the _____________ of _______________, this ____ day of August , 2013, personally appeared:

N A M EGOVERNMENT

ISSUED IDDATE AND

PLACE ISSUED

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

This Special Power of Attorney consists of two (2) pages, including this page whereon this acknowledgment is written.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on the place and date first above-written.

NOTARY PUBLIC

Doc. No. ____;Page No. ____;Book No. ____;Series of 2013.