Sample Form: SPECIAL POWER OF ATTORNEY (To Claim Check)

SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, _______________, of legal age, married, Filipino, with postal address at c/o ___________________________, do hereby appoint, name and constitute Mr. ______________________, likewise of legal age, married, with residence at _____________________________ as my true and legal representative to act for and in my name and stead and to claim my check from the NLRC Cashier representing the cash bond which I personally posted in relation to the case ______________________ vs. _____________________, bearing case number NLRC LAC No._________ / CASE No. _________, and as well as other checks, if any.

      I hereby grant my representative full power and authority to execute and perform every act necessary to render effective the power to compromise as though I myself have so performed it and hereby approving all that he may do by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of ____________________, 2017 at ________________.

_________________

Principal

Conforme:

Conforme:

_____________________

      Attorney-in-fact

Republic of the Philippines )

 _____________________) S.S

BEFORE ME, personally appeared:

            

    Name                                           ID Number                          Date/Place Issued

      

Known to me and to me known to be the same persons who executed the foregoing instrument and acknowledged to me that the same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL, on the date and place first above written.

                                                                                                            

                                                                                  Notary Public

Doc. No.______;

Page No. ______;

Book No.______;

Series of 2017