SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _______________ and presently residing at

_______________, after having been duly sworn to in accordance
with law hereby depose and say: THAT-

1. To apply for authentication of the Affidavit of

Consent to Petition from Mother which I executed on December 12,
2016;

2. To sign, seal, execute and deliver any document or

instrument necessary in carrying out into effect the power and
authority herein granted.

HEREBY GIVING AND GRANTING unto my said attorney full power

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

IN WITNESS WHEREOF, I have hereunto set my hand this ____

day of December 2016 in _________________.

_______________
Affiant

C O N F O R M E:

________________________
Attorney-in-Fact

We, the undersigned, hereby certify that the above

instrument, consists of three (3) pages, including the page which
contain the authorized signatory, was signed with our sight, who
declared that the instrument to be their Power of Attorney. We,
at the Principals request and the Principals sight and
presence, and in sight and presence of each other, do hereby
subscribe our names as witnesses on the date shown above.

1
 SIGNED IN THE PRESENCE OF:

_________________________ _________________________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

___________________________) S.S.

BEFORE ME, a Notary Public for and in

____________________, Philippines, this ____ day of
November 2016 personally appeared:

Name Competent Date of Issuance

Evidence of
Identity

Respectively known to me to be the same persons who

executed the foregoing Special Power of Attorney,
consisting of three (3) pages including this page on
which this acknowledgement is written, and they
acknowledged to me that the same are their own free and
voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and at the

place above-written.

Notary Public
Doc. No. ________;
Page No. ________;
Book No. ________;
Series of 2017.