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Republic of the Philippines)

Province of La Union…………)
San Fernando city……………..)


I, ANNIE TAN, single, Filipino citizen, and a resident of Pindangan,

Parian, San Fernando City, La Union having been duly sworn in accordance
with law, hereby depose and state that:

I am the complainant in the above-entitled case;

I have caused the preparation and filing of the foregoing Petition;

I have read and understood the factual and material allegations

therein contained and that the same are true and correct of my own
personal knowledge and are based on authentic records and documents;

I have not commenced, nor to the best of my knowledge there is

pending any action/proceeding involving the same issue in the Supreme
court, Court of Appeals or any other tribunal or agency; and should I learn
that a similar action/proceeding has been filed or pending before any such
bodies, I shall within five (5) days therefrom inform the court/agency
wherein the original pleading or sworn certification contemplated herein
has been filed.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______, 2018 in San Fernando City, La Union.

Subscribed and sworn before me on the date and place above-written.
Affiant exhibited to me her PHL Passport P01387088A.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.