SPA FORM

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SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
I, __________________, of legal age, Filipino citizen, single/married, and a
resident of Davao City, do hereby name, constitute and appoint:
Miss Dinah Patrimonio, of legal age, Filipino, single and a resident of Matina,
Davao City, Philippines.
To be my true and lawful attorney-in-fact for me and in my name, place and
stead, to do and perform the following special power to get my certified true
copy/security paper of my birth certificate at NSO- National Statistics Office, and to
apply, follow-up and get my BIR Tax Identification Number at the Office of Bureau of
Internal Revenue of Davao City.
HEREBY GIVING AND GRANTING unto my said attorney-in-fact full power and
authority whatsoever requisite and necessary 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 and shall lawfully do or cause to be done under and by virtue of these presents
IN WITNESS WHEREOF, I have hereunto set my hand at the City of Davao
Philippines, on this _____________ 2009.
DINAH P. PATRIMONIO
Attorney-in-fact
PP No. XX0673347
Valid until March 4, 2013
Issued at Davao City
_____________________
Principal
PP No. ______________
Valid Unitl ____________
Issued at _____________
SIGNED IN THE PRESENCE OF:
_____________________________ & ___________________________
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
CITY OF DAVAO
) S.S.
x-----------------------------------------------x
BEFORE ME, personally appeared ______________ and DINAH PATRIMONIO with
passport no. stated above, known to me to be the same person who executed the foregoing
Special Power of Attorney and they acknowledge to me that same is true act and voluntary deed.
IN WITNESS WHEREOF, I have hereunto affix my signature and notarial seal, this
______________ 200_ at the City of Davao, Philippines.
Doc. No. ____
Page No. ____
Book No. ____
Series of 200__
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