SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
I, (name of person authorized to claim the smart card kit), of legal age, Filipino, holding
the position of (position), (department/office in PhilPaSS-participant bank), (name of
PhilPaSS-participant bank), with office address at (office address), pursuant to Board
Resolution dated _____________ and reflected in the attached Secretary’s Certificate, do
hereby appoint, name and constitute, (name of employee of PhilPaSS-participant bank),
(position), (department/office in PhilPaSS-participant bank) of (name of PhilPaSS-participant
bank), as my true and lawful attorney-in-fact, for me and in my name, place and stead, to
accept/pick-up the following smart card kit/s (smart card, smart card reader, and smart card
account envelope):
Name of Authorizer
(add rows, as may be necessary)
Hereby giving and granting unto my said attorney-in-fact full power and authority to do
and perform every act and thing whatsoever requisite and necessary 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 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 hand this ________ day of _______ 2014
at __________________.
(name of person authorized to claim the smart card kit)
Principal
ACKNOWLEDGMENT
Republic of the Philippines )
______________________ )S.S.
Before me, a Notary Public for and in the City of ___________, on this ______ day of
_________ 2014, appeared (name of person authorized to claim the smart card kit) with
(competent evidence of identity) issued on (date of issue) at (place of issue), known to me and
to me known to be the same person who executed the foregoing instrument and acknowledged
to me that the same is his free and voluntary act and deed.
IN WITNESS WHEREOF, I have hereunto set my hand, the day, year and place abovewritten.
NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2014.