SPECIALPOWEROFATTORNEY
KNOWALLMENBYTHESEPRESENTS:
I, (insertdetailshere),oflegalage,Filipino, withaddressat (insertdetailshere),dohereby
name,constituteandappoint(insertdetailshere),mymother,withaddressat(insertdetailshere),tobe
mytrueandlawfulattorney,forandinmyname,placeandstead,andformyownbenefit,todoallacts
necessary,towit:
[Link];
[Link],andtosignany
papersthatareneededtohavetheabovementionedchildadmittedtoahospitalforsuchpurpose,oras
mayberequiredtomaintainthehealthoftheabovementionedchild.
[Link]
problemsthat mayarisefromschool attendance,andtosignanypapersthat are necessaryfor such
purposeorsignotherdocumentsrelatingtothechild'swelfareatschool.
[Link]
child.
[Link],health,andgeneralcareoftheabovementionedchildasmay
berequiredornecessary.
[Link],appointing(insert details here) asmyagentandattorneyin
factperformingandactingformeinaparentalcapacityformychild[LegalNameofChild]willbe
revokedautomaticallywithinone(1)yearfromdateofnotarizationasindicatedbelow.
[Link]
child.
8. To give consent and permission and the authority to sign in my behalf to secure DSWD
clearanceallowingmychildtotravelalonetocometomeorherauntabroad;
[Link]
Withfullpowerandauthoritytomake,sign,seal,executeanddeliveranyandalldocuments,and
otherwritingsofwhatevernatureorkindinconnectionthereto;andingeneral,todoallotheracts,deeds,
matters,andthingswhatsoeverinfurtheranceofthepowerthusgranted;
HEREBYGIVINGANDGRANTINGuntooursaidattorneyfullpowerandauthoritytodoand
performallandeveryactrequisiteornecessarytocarryintoeffecttheforegoingauthorities,asfullytoall
intents and purposes through its authorized representatives might or could lawfully do if personally
present,withfullpowerofsubstitutionandrevocation,andherebyratifyingandconfirmingallthatthe
saidattorneysshalllawfullydoorcausetobedonebyvirtuehereof.
INWITNESSWHEREOF,Ihavehereuntosetmyhandthis_______dayof__________,2016,
at________________,Philippines.
MARYCARQUILOP
1
SIGNEDINTHEPRESENCEOF:
__________________________ _________________________
ACKNOWLEDGEMENT
REPUBLICOFTHEPHILIPPINES)
CITYOFTAGUIG )S.S.
BEFOREME,aNotaryPublicforandintheabovejurisdiction,this______dayof_______________,
2016personallycomeandappeared:
NAME IDENTIFICATION DATE/PLACEOF
DOCUMENTPRESENTED ISSUE
MARYCARQUILOP
knowntomeandtomeknowntobethesamepersonwhoexecutedtheforegoinginstrumentandthey
acknowledgedbeforemethatthesameistheirfreeandvoluntaryactanddeedandthatofthecorporation
whichtheyrepresent.
WITNESSMYHANDANDSEALonthedateandattheplacefirstabovewritten.
[Link].________;
PageNo.________;
BookNo._______;
Seriesof2016.