Certification of No Case Involving the Same Issues and Parties

I, (name of complainant), of legal age, Filipino and a resident of

__________________________________________, do hereby swear, under oath, that:

1. I have not filed any case or complaint involving the same issues and the same parties
before any government agency or office or judicial court;

2. There is no pending case or complaint involving the same issues and the same parties
before any government agency or office or judicial court; and

3. If I should later on learn that there is a pending case or complaint involving the same
issues and the same parties, I will inform the Anti-Red Tape Authority within three (3)
days from knowledge of such fact.

4. I understand that my complaint or case with the Anti-Red Tape Authority will be
dismissed if it is found that I have filed another case or complaint involving the same
issues and the same parties before any government agency or office or judicial court or
if it is found that the same case or complaint is the subject matter of another complaint or
case involving the same parties and issues which is also pending with another
government agency or office or judicial court.

(Date of issuance), (place of issuance).

________________________________________
(Signature over printed name of Complainant)

Republic of the Philippines

City of _________________ S.S.

Subscribed and sworn to before me this _____day of _________________, 20____ in

the City of ______________________________. Affiant exhibited to me his/her competent
evidence of identity consisting of ______________________________, issued on / valid until
__________________________ and issued by ______________________.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 20___.