REPUBLIC OF THE PHILIPPINES)

CITY OF BLANK ) S.S.

VERIFICATION AND CERTIFICATION AGAINST FORUM

SHOPPING

I, MR. X, of legal age, Filipino, single and a resident of No. 7, Rizal

Street, Cabagñan, Blank City, after having been duly sworn to in accordance
with law, hereby depose and say:

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

2. That I have cause the preparation of the foregoing Complaint and I

have read the same and understood the contents thereof;

3. That the allegations contained therein are true and correct of my

own knowledge and based on authentic records;

4. That the pleading is not filed to harass, cause unnecessary delay, or

needlessly increase the cost of litigation;

5. That the factual allegations therein have evidentiary support or, if

specifically, so identified, will likewise have evidentiary support
after a reasonable opportunity for discovery; and

6. That I further certify that:

a. I have not theretofore commenced any other action or

proceeding or filed any claim involving the same issues or
matter in any court, tribunal, or quasi-judicial agency and, to the
 best of my knowledge, no such action or proceeding is pending
therein;
b. If I should thereafter learn that the same or similar action or
proceeding has been filed or is pending before the Supreme
Court, the Court of Appeals or any other tribunal or quasi-
judicial agency, I undertake to report such fact within five (5)
calendar days therefrom to the court or agency wherein the
original pleading and sworn certification contemplated herein
have been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day

of January 2021 at Blank City, Philippines.

MR. X
Affiant

SUBSCRIBED AND SWORN to before me, a notary public in and

for Blank City this 26th day of January 2021. Affiant personally came
and appeared with his Driver’s License No. 698466 issued by the
Land Transportation Agency on January 4, 2021 at Blank City,
bearing his photograph and signature, known to me as the same
person who personally signed the foregoing instrument before me and
avowed under penalty of law to the whole truth of the contents of said
instrument.

Doc. No. 9;
Page No. 4;
BookNo.1;
Series of 2021.