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Document 30

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SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ________________ single, of legal age, ____________citizen, presently residing at


______________________________________________________________________________
__, do hereby name, constitute and appoint, KARYL VIC P. PILACAN, Filipino citizen, of legal
age, single, residing at #43-A sarok Camp 7, Baguio City 2600 Philippines, to be my true and
lawful attorney, for me and in my name, place and stead, and to do and perform the following
acts, to wit:

1. To file the petition for legal Custody of the minor __________ where I am the petitioner;
and
2. To sign the verification and certification against forum shopping of the same petition.

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 or proper to be done in
the above premises as fully to all intents and purposes as I might or could lawfully do if
personally present and acting in person, hereby ratifying and confirming all that my said
attorney-in-fact shall lawfully do and cause to be done by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hands this ______ day of


________________ 20___, in ____________________, ___________________________.
_________________________
Principal
Passport No. _________________________
Issued on ____________________________
Issued in _____________________________

Signed in the presence of:


____________________________ ____________________________

SUBSCRIBED AND SWORN to before me this ______ day of ___________, ________, in


__________________________________.

Doc. No. ________;


Service No. ______;
Page No. ________; __________________________
Book No. ________; Administering Officer
Series of _________.

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