REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

x----------------------------x

VERIFICATION/CERTIFICATION OF
NON-FORUM SHOPPING

I, ______________________, of legal age, _______, Filipino, and a resident of

_________________________________________, Philippines, after having been duly
sworn to in accordance with law hereby depose and say:

1. That I am the Petitioner in the above-captioned case;

2. That I have read and caused the preparation of the foregoing Petition and
that all the allegations contained therein are true and correct of my personal
knowledge or based on authentic records;

3. That I have not commenced any other action or proceedings involving the
same issues in the Supreme Court, Court of Appeals or any other tribunal or
agency, and to the best of my knowledge, no such action or proceeding is
pending before the Supreme Court, the Court of Appeals or other tribunal or
agency;

4. That if I should hereafter learn that a similar action or proceeding has been
filed or is pending in the Supreme Court, Court of Appeals, or any other
tribunal or agency, I undertake to report such fact within five (5) days
therefrom to the court or agency wherein the original pleading or sworn
certification contemplated herein has been filed.

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

______________ 2019 in the City of ______________, Philippines.

_________________________
Affiant
ID No. 703-581-318-000
Issued by: BIR

SUBSCRIBED AND SWORN TO before me, a Notary Public for and in the City
and Province of Iloilo, this ______ day of _______________ 2019 in the City of
__________________, Philippines, affiant appeared with his I.D. No. listed below his
name above whose personally known to be the same person to the Notary Public or
identified by the Notary Public through competent evidence of identity as defined by the
2004 Rules on Notarial Practice pursuant to Supreme Court EN BANC A.M No. 02-8-13
SC Resolution. That the herein person represented to the Notary Public that the signature
on the instrument or document was voluntarily affixed by him.

Doc. No. __________;

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