Republic of the Philippines )

City of _______________ ) S.S.

VERIFICATION AND CERTIFICATION AGAINST FORUM SHOPPING

X, after being duly sworn, hereby deposes and states:

That he is the plaintiff in the above-entitled case; that he has sauced the foregoing Complaint to be
prepared; that he has read the same and that the allegations of fact; therein contained are true of his personal
knowledge or based on authentic documents;

That (a) he has not heretofore commenced any action or filed any claim involving the same issues in any
court, tribunal or quasi-judicial agency, and to the best of his knowledge, no such other action or claim is pending
therein; and (b) is he should hereafter learn that the same or similar action or claim has been filed or I pending, he
shall report that fact within five( 5) days therefrom to this Honorable Court.

IN WITNESS WHEREOF, I have signed this instrument on _____________.

(Sgd.) X

SUBSCRIBED AND SWORN to before me, this _____________, by _____________ who exhibited to me (his/her)
Community Tax Certificate No. _____________ issued at _____________, Philippines on _____________.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;

NOTICE OF HEARING

Atty. M
Counsel for the defendant/plaintiff
(Address)

Sir:
Kindly take notice that the foregoing petitions will be submitted to the Honorable Court on September 27,
2010, for its consideration and resolution.

Atty. NY