Republic of the Philippines

Supreme Court of the Philippines

Manila

Xxx,
Complainant,

Case No.
Administrative case for Dishonesty
- versus-
Yyy,
Respondent,
x------------------------------------x

COMPLAINT-AFFIDAVIT AGAINST YYYFOR AN

ADMINISTRATIVE CASE FOR DISHONESTY

I, Xxx, of legal age, married, Filipino and a resident of _____, after

having been sworn to in accordance to law, hereby depose and say:

1.

IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of

September 2018 in Legazpi City, Philippines.

Xxx
Affiant

SUBSCRIBED AND SWORN to before me, in Legazpi City, Philippines,

this ____, by the affiant, who has satisfactorily proven to me her identity
through her_______________________, that she is the same person who
executed the foregoing.

xxx
Notary Public

-1-
 xxxx

Doc No. ____

Page No. ___
Book No. ___
Series of 2018

VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, Xxx, of legal age, after having been duly sworn in accordance with
law, depose and state that:

1. I am the complainant in the above-stated case;

2. I caused the preparation of the foregoing complaint;

3. I have read the contents thereof and the facts stated therein are
true and correct of my personal knowledge and/or on the basis of
copies of documents and records in my possession;

4. I have not commenced any other action or proceeding involving

the same issues in the Supreme Court, the Court of Appeals, or
any other tribunal or agency;

5. To the best of my knowledge and belief, no such action or

proceeding is pending in the Supreme Court, the Court of Appeals,
or any other tribunal or agency;

6. If I should thereafter learn that a similar action or proceeding has

been filed or is pending before the Supreme Court, the Court of
Appeals, or any other tribunal or agency, I undertake to report
that fact within five (5) days therefrom to this Honorable Office.

Xxx
AFFIANT

SUBSCRIBED AND SWORN to before me, in Legazpi City, Philippines,

this 17th day of September 2018, by the affiant, who has satisfactorily

-2-
proven to me her identity through her __________________________, that
she is the same person who executed the foregoing.

xxx
Notary Public

Doc No. ____

Page No. ___
Book No. ___
Series of 2018

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