The Lawphil Project – Arellano Law Fovndation

FORM 1-A-SCC

VERIFICATION AND CERTIFICATE OF

NON-FORUM SHOPPPING

I._____________________________________________, of legal age,

(Name)

_____________________________ _______________________, and a resident

(citizenship) (civil status)

of _______________________________________________________________,

after having been duly sworn to in accordance with law, hereby, depose and say:

1. That I am the ____________________in the above-entitled case and have caused

this ___________________________________ to be prepared; that I 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 the fact to the Court within five (5) days
therefrom.

IN WITNESS WHEREFOR, I have hereunto set my hand this ____ day of

__________________,20____.

Affiant

SUBSCRIBED AND SWORN to before me this______day of _______________, 20_____

.

NOTARY PUBLIC