THIS IS TO AUTHORIZE (Name), of legal age, a resident of (Address) , to do and perform any and all of the following acts:
(In case of a corporation, replace above with: THIS IS TO AUTHORIZE [Name of Corporation], a domestic corporation existing under and by virtue of the laws of the Philippines, with principal office located at [Address], to do and perform the following acts:)
TO SELL my house and lot located at (Address), more particularly described as follows:
Block No. _________ Lot No. __________
Lot Area: __________ square meters
Transfer Certificate of Title No. __________
That (Name /Corporation) shall receive a commission fee equivalent to FIVE (5%) PERCENT of the total selling price as stipulated in the Deed of Sale or Contract to Sell, payable upon the execution of the instrument.
This exclusive (or Non-Exclusive) authority shall become ineffective only after 30 (60 or 90) days from receipt of either party of a written notice terminating such authority.
_______________________________
OWNERSignature Over Printed Name
Name of Owner: ________________________________
Spouse: ________________________________________
Home Address: _________________________________
Telephone Nos. _________________________________
Office Address: _________________________________
Telephone Nos. _________________________________
Date: _______________________