Sample Form: SPECIAL POWER OF ATTORNEY (To Represent In A Mediation)

SPECIAL POWER OF ATTORNEY

  

KNOW ALL MEN BY THESE PRESENTS:

      I, ___________________, of legal age, married, Filipino, with postal address at ________________________________, do hereby appoint, name and constitute Mr. ________________________, likewise of legal age, singe/married, with residence at _______________________________ as my true and legal representative to act for and in my name and stead and to represent me during the mediation proceedings before the Philippine Mediation Center Unit in the Court of Appeals relative to the case docketed as CA-G.R. SP No._________, to offer, negotiate, accept, decide and enter into a compromise agreement without need of further approval by or notification to me.

     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:

_____________________

      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.

                                                                                                            

Doc. No.______;

Page No. ______;

Book No.______;

Series of 2017