CONFIRMATION, AFFIRMATION AND RATIFICATION

KNOW ALL MEN BY THESE PRESENTS:

I, ____, of legal age, Filipino citizen and a resident of Brgy. ____, Iloilo, Philippines, by
these presents, hereby stated, that:

1. I am the respondent in Civil Case No. ___entitled “__, vs. __, Respondent” for Support
with Application for Support Pendente Lite pending before the Regional Trial Court,
Branch __, ___;
2. On ___, I filed an Answer (With Verified Comment) with a Verification executed for in
and my behalf by my brother, ___, and counsel, ATTY. PAUL __, recorded in the
Notarial Registry of Notary Public Atty. ___ as Doc. No. 93; Page No. 20; Book No. LII;
Series of 2021;
3. I affirm, confirm and ratify that ___ and ATTY. PAUL ___ are my authorized
representatives to execute and sign for and in my behalf the said Verification
attached to my Answer (With Verified Comment);
4. Likewise, I affirm, confirm and ratify that:
a. I have caused the preparation of the Answer (With Verified Comment) dated
___;
b. I have read and known the contents of aforesaid pleading, and that (a) the
allegations contained therein are true and correct based on my personal
knowledge or based on authentic documents; (b) the pleading is not filed to
harass, cause unnecessary delay, or needlessly increase the cost of litigation;
and (c) the factual allegations herein have evidentiary support after
reasonable opportunity for discovery.

IN WITNESS WHEREOF, we have hereunto set our hands this _________________ in

the City of ___, Philippines.

___
PhilHealth ID No. ___

Signed In the presence of:

__________________________ _________________________

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES}
CITY OF _____ } s.s.

BEFORE ME, this ____________________ in the City of ___, Philippines, personally

appeared the Principal with his identification indicated below his name as their competent
proof of identity, known to me to be the same person who executed the foregoing
instrument, and who acknowledged to me that the same is his free act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal, on
the day, year, and place above written.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.