Republic of the Philippines ))

_______________ )) S.S.

VERIFICATION & CERTIFICATION AGAINST

FORUM SHOPPING

I, JUAN DELA CRUZ, Filipino, of legal age and with residence

address at Brgy. Da-anbanwa Lambunao, Iloilo, after having been sworn
to in accordance with law, depose and state as follows:

1. I am the complainant-appellant in the above-mentioned case;

2. I have caused the preparation of the MEMORANDUM OF

APPEAL, have read it and understood it and the allegations
therein contained are true and correct of my personal
knowledge and based on the authentic documents in my
possession;

3. In compliance with Rule 7, Section 5 of the 1997 Rules of

Court, I hereby certify that I have not commenced any action or
proceeding involving the same issues in the Supreme Court, the
Court of Appeals or any other tribunal or agency;

4. If I should thereafter 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 fact within five (5) days therefrom to the court or agency
wherein the original pleading and sworn certification
contemplated herein have been filed.

Further affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day

of __________________ 2019.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of

_______________2019 in _________________, affiant having exhibited to me
her identification card as she purports to be.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2019.