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Republic of the Philippines)

Tarlac City )
x----------------------------x

VERIFICATION AND CERTIFICATION OF


NON-FORUM SHOPPING

I, RODYNEL R. JIMENEZ, of legal age, Filipino citizen, and with


residence and postal address at Barangay Atioc, Tarlac City, after having
been duly sworn to in accordance with law, do hereby depose and state:

1. That I am the Petitioner in the above-entitled case;

2. That all the contents and allegations thereat are true and correct to
my own knowledge and belief and the documents therewith attached
are based on authentic records;

3. That I have not commenced in any other proceedings or actions


involving the same issues in this case in the Supreme Court, the Court
of Appeals or any other tribunal or agency;

4. That to the best of my knowledge, no such action or proceeding is


pending in the Supreme Court, the Court of Appeals or any other
tribunal or agency;

5. That if I should learn that a similar action or proceeding has been filed
or is pending in the Supreme Court, the Court of Appeals or any other
tribunal or agency, I undertake to report the same within Five (5) days
from knowledge hereof to this Honorable Court.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


_____ day of ______________ at Tarlac City, Philippines.

RODYNEL R. JIMENEZ
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME. Affiant exhibiting to me


his competent proof of identity.

Doc. No. : ____;


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