SPECIAL POWER OF ATTORNEY
I, BENSALI OMARALI, hereby name, appoint and constitute, HADJA ATIKA DEGUSMAN, to be my true and lawful attorney in fact, to act on my behalf and in my name, to execute and perform all or any of the following acts, deeds, matters and things, in connection with claiming my renewed passport with the Department of Foreign Affairs Affairs to wit: IN WITNESS WHEREOF, the Parties have hereunto set their hands on this __ day of ______
!"# in the $ity of %amboanga, Philippines& "& 'o recei receive ve and claim, claim, in my behalf, behalf, my renewed renewed passport passport with with the Depart Departmen mentt of Foreig Foreign n Affairs( & 'o negotia negotiate te and communicate communicate with the Departme Department nt of Foreign Affair Affairss as to the release release of my renewed passport, to ma)e, sign and execute the documents that may be re*uired thereof pursuant to the release of the passport( #& 'o file file the criminal criminal and civil civil complaints complaints before before the appropriate appropriate courts, courts, administrat administrative ive or other gover governm nment ent agenc agencie ies, s, incl includ udin ing g +ara +arang ngay ay conci concili liat atio ion n proc procee eedi ding ngs, s, agai agains nstt perso person n in connection with the claim of benefits( & 'o appear appear on behalf behalf of us in any court court or adminis administra trati tive ve proceedin proceedings gs -includi -including ng +arangay +arangay conciliation. thereof, with full powers and authority to consider and enter into an amicable settlement, to submit to alternative modes of dispute resolution, to enter into stipulations and admis admissi sion onss of fact fact and and of docum documen ents ts and and such such other other matter matterss as may aid in the the prom prompt pt disposition of the action( and /& 'o perform perform all other other acts acts necessary necessary to carry carry out the foregoi foregoing ng purposes& purposes& 0121+3 4I5I64 A6D 42A6'I64 unto out Attorney7in7Fact full power and authority to do and perform all and every act and thing whatsoever re*uisite, necessary or proper to be done and about the premises as fully to all intents and purposes as we might or could do if personally present, and acting in person( and 0121+3 2A'I 2A'IF3I60 F3I60 A6D $86FI29I64 all that our said Attorney7in7fact shall lawfully do or cause to be done under and by virtue of these presents& IN WITNESS WHEREOF, the Parties have hereunto set their hands on this __ day of ______ !" in
the $ity of %amboanga, Philippines BENSALI OMARALI
Principal igned in the Presence of _________________
_________________
ACKNOWLEDGEMENT
2epublic of the Philippines. %amboanga $ity& $ity&&&.&& &&.&& x7777777777777x +1F821 91, this __ day of ______, !" in the %amboanga $ity, Philippines, personally appeared BENSALI OMARALI, with ___________ with number _______________ issued at______ on ________ )nown to me and to me )nown to be the same person who executed the foregoing pecial Power of Attorney consisting of one page and he ac)nowledged ac)nowledged to me that the same is his free act act and deed& I6 ;I'61 ;01218F, ;01218F, I have placed my hand and seal on the date and at the place first above7written& Doc& 6o&: Page 6o&: +oo) 6o&: eries of _____&
