SPECIAL POWER OF ATTORNEY

I, ______________________________________________________________, of legal
age, Filipino, and with address at ______________________________________
_______________________________________________________________________, after
being sworn in accordance with law, hereby state:
1.

I am authorized / applying for authority to provide transportation services in the

Philippines as a Transportation Network Vehicle Service ("TNVS") under the regulations
of the Land Transportation Franchising and Regulatory Board ("LTFRB").

2.

I intend to enter into an agreement or agreements ("Agreements") with Uber Systems,

Inc. ("USI"), a Transportation Network Company duly accredited by the LTFRB and/or
its affiliates or related parties, including Uber Philippines B.V. (collectively referred to as
"Uber") for the purpose of accessing and using Uber's technology application and
other related services, being accredited as a TNVS, performing the
activities or providing the services of a TNVS, and of enhancing my
transportation services.

3.

For the purposes hereunder stated, I hereby name, constitute and appoint
___________________________________________________________
with address at:
___________________________________________________________
___________________________________________________________
to be my lawful attorney-in-fact, for and in my name, place and stead, to do and perform
all acts necessary or proper for me to become a TNVS and/or to be able to provide
transportation services using the Uber technology application, including (a) processing,
sharing and disclosing relevant personal information about me to Uber; (b) negotiating,
transacting or contracting with Uber, including the negotiation for / execution of the
Agreements and obtaining accreditation/good standing as a TNVS; (c) receiving any
payments due to me and/or making or authorizing payments due from me under the
Agreements; (d) exercising all my rights and performing all my obligations under the
Agreements; and (e) pursuing, entering into compromises or waiving any claims or
causes of action I have against Uber or defending any such claims or causes of action
against me by Uber.

4.

I, however, withhold from my attorney-in-fact the authority to receive summons on my

behalf.

5.

I hereby grant my attorney-in-fact full power and authority to do and perform any and all
other acts and things necessary and proper in connection with the implementation of the
foregoing authority, as fully to all intents and purposes as I might or could lawfully do if
personally present. I hereby ratify and confirm all that said attorneys-in-fact shall lawfully
do or cause to be done or shall have lawfully done or have caused to be done in accordance
with the foregoing authority.

IN WITNESS WHEREOF, I have hereunto signed these presents on this ___ day of
_______________ 2015.
___________________________
1

Signature over print name

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
CITY OF _________
) ss.

BEFORE ME, a Notary Public for and in the city named above, personally appeared:
Competent Evidence of Identity
Type of ID
ID Number and
Expiry Date (if
applicable)

Affiant

Community Tax Certificate

Number
Date/Place
Issued

1
2

executed this Special Power of Attorney, who made oath to the truth thereof, and he / she
acknowledged to me that the same was his / her free and voluntary act.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on the date
and at the place indicated above.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2015.