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SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

I, ____________________, Filipino citizen, of legal age, married, with residence at ____________________,


Zamboanga del Norte, do hereby name, constitute, and appoint ,________________________________________ of the
Department of Agrarian Reform of Zamboanga del Norte, of legal age, married, with residence at
______________________, to be my true and lawful Attorney-in-Fact for me in my name, place and stead, to do and
perform all of the following acts, to wit:

1. With my full consent and authority, to get the tax declaration of my Certificate of Title, of Lot
No.____________, covered by TCT/OCT ________________________, with Collective Certificate of Land
Ownership Award (CCLOA) No.___________ at the Provincial Assessor’s Office of Zamboanga del Norte.
The Tax Declaration is hereby needed as one of the requirements for individual titling of our CCLOA title;

2. To perform all other acts necessary to carry out the above purpose and authority in my behalf.

HEREBY GIVING AND GRANTING unto my said Attorney-in-Fact full power and authority to do and
perform any and every act requisite and necessary to be done in and about the premises as fully to all intents and purposes
as I might or could do, I personally present and acting in person, HEREBY RATIFYING AND CONFIRMING all that my
said Attorney-in-Fact may also do or cause to be done under and by virtue of these presents.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of September 2022 in Dipolog City,
Zamboanga del Norte.

With my conformity:

__________________ ____________________
Principal Attorney-in-Fact
ID ID

SIGNED IN THE PRESENCE OF:

______________________________________ ______________________________________

ACKNOWLEDGMENT
Republic Of The Philippines )
City of Dipolog) S.S.

BEFORE ME, this December 29, 2021, in Dipolog City, Zamboanga del Norte personally appeared
_____________________ and ____________________, with their competent proof of identity indicated below
their names as above indicated, all known to me, and to me known, to be the same person who executed the
foregoing instrument and hereby acknowledged to me that the same is their free and voluntary act and deed.

Doc No. ________;


Page No. ________;
Book No. ________;
Series of 2022.

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