VERIFICATION AND CERTIFICATE OF NON-FORUM SHOPPPING

I, _____________________________________________, of legal age,

(Name)
_____________________________ _______________________, and a resident of
(Citizenship) (Civil Status)
_______________________________________________________________, 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