Republic of the Philippines )

PROVINCE OF XXXX ) s.s.

MUNICIPALITY OF XXXXXX )

VERIFICATION AND CERTIFICATE OF

NON-FORUM SHOPPPING

The undersigned, after having been duly sworn to in

accordance with law, hereby, depose and say:

1. That I am the complainant in the foregoing case and have

caused the preparation of the foregoing; that I have read
and understood its contents which are true and correct of
my own personal knowledge and/or based on authentic
records.

2. That I have not commenced any action of proceeding

involving the same issue in the Supreme Court, the Court of
Appeals or any other tribunal or agency; that to the best of
my knowledge, no such action or proceeding is pending in
the Supreme Court, the Court of Appeals or any tribunal or
agency, and that, if I should learn thereafter that a similar
action or proceeding has been filed or is pending before
these courts of tribunal or agency, I undertake to report that
fact to the Court within five (5) days therefrom.

IN WITNESS WHEREFORE, I have hereunto set my hand this

____th day of __________, 2020 hereat XXXX.

MILAGROSA
Affiant

SUBCRIBED AND SWORN TO before me this ____th day of

__________, 2020 in XXXXX.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.