VERIFICATION AND

CERTIFICATION OF NON-FORUM SHOPPING

I, ________________________, of legal age, single, Filipino citizen, and

resident of ___________________________________________________,
after having sworn to in accordance with law hereby depose and state that;

1. I am the petitioner in the above-entitled petition for appointment as

notary public;

2. I have caused the preparation of the herein petition and the contents
thereof are true to the best of my knowledge;

3. I have not commenced any action or proceeding involving the same issue
in the Supreme Court, the Court of Appeals, or any other tribunal;

4. To the best of my knowledge, no such action or proceeding is pending in

the Supreme Court, Court of Appeals, or different Divisions thereof, or
any other tribunal or agency;

5. If there is any other action or proceeding which is pending, or should I

thereafter learn that a similar action or proceeding has been field or is
pending before the Supreme Court, the Court of Appeals, or different
Divisions thereof, or any other tribunal or agency, I hereby undertake to
report that fact or the status thereof within five (5) days therefrom to this
Honorable Court.

IN WITNESS WHEREOF, I have hereunto signed my name this

_________ day of _______________, 2019 at Batangas City, Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me, this _____ at Batangas

City by affiant exhibiting to me her _________________with number
_________________ valid until _______.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.