Special Power of Attorney

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SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:


I, JARA JOBOCO PACANZA, by these presents do hereby depose and state that I am:

1. Of legal age, single and a resident of _____________________________________________________;


2. The owner of Kabayan Savings Account No/s.__________________ maintained with
___________________________________________;
3. In possession of the foregoing since the opening of the account/s and there is no conflict or dispute
arising from my ownership and possession of the same;
4. NAMING, CONSTITUTING AND APPOINTING ________________________________ (name of
attorney-in-fact), who is of legal age, single/married and a resident of
_________________________________________________, as my true and lawful attorney-in-fact, for
me and my name, place and stead, for my own use and benefit, to do and perform any or all of the
following acts and things, to wit:

(a) File a claim for payment of the deposit insurance with the Philippine Deposit Insurance Corporation
(PDIC) for the above-stated account/s;
(b) Sign all documentary requirements relative thereto;
(c) Receive cash (if the amount is P10,000 & below) or check payment from PDIC for my insured deposit.

HEREBY GIVING AND GRANTING unto my 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 attorney-in-fact or substitute shall lawfully do or cause to be done by virtue of
these presents;

HEREBY ASSERTING that I shall be held personally liable to any person, natural or juridical, that may be
prejudiced by my representations, in addition to other liabilities, civil or criminal, that may arise
therefrom; hereby releasing and discharging PDIC from any and all further obligations in connection with
this claim; and I further undertake to refund PDIC the amount paid to me/received by my attorney-in-
fact including interest thereon and indemnify PDIC, the bank and/or third parties for any loss or damage
occasioned by such payment.

IN WITNESS WHEREOF, I have hereunto set my hand on this ___ day of ____________ at
___________________.
___________________________________
Principal
ID/ No. ____________________________
Issuance/Validity Date _____________
Conforme:

____________________________________
Name & Signature of Attorney-in-Fact
Signed in the presence of:

___________________________ __________________________

ACKNOWLEDGMENT
Republic of the Philippines)
______________________) S.S.

BEFORE ME, a Notary Public for and in _____________________________ on this ______ day of
____________________, personally appeared ____________________________________, known to
me to be the same person who executed this Special Power of Attorney and acknowledged to me that
the same is his/her free and voluntary act and deed.

Witness my hand and seal.

Notary Public
Doc. No. _________;
Page No. _________;
Book No. ______ __;
Series of _________.

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