VERIFCATION AND CERTIFICATION AGAINST

NON-FORUM SHOPPING, SPLITTING A SINGLE CAUSE OF ACTION

AND MULTIPLICITY OF SUITS

I, _________, of legal age, Filipino, married to ________, and a resident of

__________, on oath, state:

1. That I am the Plaintiff in the above-entitled case that have caused this
Statement of Claim to be prepared; that I read and understood its contents
which are true and correct of my own personal knowledge and/or based on true
records;

2. That I have not commenced any action or proceeding involving the same issue
or subject matter in the Supreme Court, the Court of Appeals or any other
tribunal or agency, particularly before the Office of the City Prosecutor of
Manila; that to the best of my knowledge, no such action or proceeding
is pending in the Supreme Court, the Court of Appeals or any other 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 or tribunal or
agency, I undertake to report that fact to the Court within five (5) days
therefrom;

3. That the filing of this case is not in violation of the rule against splitting a
single cause of action or multiplicity of suits.

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

2020.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this __________ day of

____________, 2020 at the City of Manila, the affiant having shown to me his valid
government issued identification card _______________________, with the
following details: ______________________________.

___________________________
NOTARY PUBLIC

Doc No. _____:

Page No. ____;
Book No. ____;
Series of 2020.