WHEREAS, I, _____________________, of legal age, single/married, resident of _______________, by a certain public instrument made and executed in _____________ on ___________________ before ____________________, Notary Public for and in the _________________, and bearing Not. Reg. No.______________, Page ____________, Book ______________, Series of 200___ of his notarial register, did name, constitute and appoint _______________, resident of _________________ my true and lawful ATTORNEY-IN-FACT, for the purpose and with powers mentioned in said public instrument; WHEREAS, the said public instrument or Power of Attorney, was duly registered in the Office of the Register of Deeds of ________________ on __________________, 200__, as per Entry No. ________, Vol. ___________, Book ____________, of said Office. NOW, THEREFORE, I, ____________________, by virtue of these presents, hereby, REVOKE, ANNUL, and make VOID the said power of attorney and all powers and authority therein or thereby given or granted, or intended to be given or granted to said _________________________. IN WITNESS WHEREOF, I have hereunto set my hands this __________ day of ______________________, 200_, at __________________, Philippines. ________________________
SIGNED IN THE PRESENCE OF:
_________________________ ________________________ (Witness) (Witness) REPUBLIC OF THE PHILIPPINES ) PROVINCE OF _______________ ) SS MUNICIPALITY OF ___________ ) BEFORE ME, this ________ day of _________, 20___ in the Municipality of _______________, Province of ___________________, Philippines, personally appeared _________________________, with Community Tax Certificates No. issued at ________________, on ____________, _______________ 20__, known to me to be the
same person who executed the foregoing instrument, and he acknowledged to me that the same is his free act and deed. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal, the day, year and place above written.
NOTARY PUBLIC
Doc No. ______;
Page No. ______; Book No. ______; Series of 200__.