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.