REPUBLIC OF THE PHILIPPINES }

} S. S.

VERIFICATION & CERTIFICATION

ON NON- FORUM-SHOPPING

I, _________ of legal age, Filipino and with residence at , after having been duly
sworn to in accordance with law, hereby depose and state:

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

2. That I caused the foregoing COMPLAINT to be prepared; and I have read the
contents thereof, which are true and correct to my own personal knowledge; and based on
authentic records/documents;

3. That this pleading is not filed to harass, cause unnecessary delay, or needlessly
increase the cause of litigation;
4. That the factual allegations therein have evidentiary support or, if so
specifically so identified, will likewise have evidentiary support after reasonable
opportunity for discovery
5. That I have not commenced any action or filed any claim involving the same
issues in any court, tribunal or quasi-judicial agency and, to the best of my knowledge, no
such other action or claim is pending therein; (b) if there is such other pending action or
claim, a complete statement of the present status thereof; and (c) if he or she should
thereafter learn that the same or similar action or claim has been filed or is pending, he or
she shall report that fact within five (5) calendar days therefrom to the court wherein his
or her aforesaid complaint or initiatory pleading has been filed, pursuant to Sec. 5,
Rule 7, Rules of Civil Procedure.

IN WITNESS WHEREOF, I have signed this Verification and Certification

this ____th day of ____________ 2020.

ID NO.

SUBSCRIBED AND SWORN to before me this ____ day of __________ 2020.

Affiant exhibited to me his above mentioned I.D.s hereinabove below their names

NOTARY PUBLIC
DOC. NO. _____
PAGE NO. _____
BOOK NO. _____
SERIES OF 2020