VERIFICATION & CERTIFICATION

OF NON-FORUM SHOPPING

I, TAYLOR S. GOMEZ, Filipino, of legal age, single, Filipino, a resident of

Block 2 Lot 22, Dos Street, Math Ville Subd., Brgy. Numero, Bacolod City,
Negros Occidental, after having been duly sworn in accordance with law hereby
state:

1. That I am the petitioner of the above instant case.

2. That I have caused he preparation of the above-entitled petition.
3. That I have read the same and that it is true and correct based on my
personal knowledge or based on authentic records.
4. That I hereby certify under oath in this petition as follows: I have not

theretofore commenced any action or filed any action or claim involving the same
issue in any court, tribunal or quasi-judicial agency and, to the best of my
knowledge, no such other pending action or claim is pending therein; If there is
such other pending action or claim, a complete statement of the present status
thereof; and if I should thereafter learn that the same or similar action or claim
has been filed or is pending, I shall report that fact within five (5) days therefrom
to the court wherein the aforesaid complaint or initiatory pleading has been filed.

IN WITNESS WHEREOF, I hereunto affix my signature this 10th day

of June, 2021, here at Bacolod City, Negros Occidental, Philippines.

TAYLOR S. GOMEZ
Affiant
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

CITY OF BACOLOD )S.S.

BEFORE ME, a Notary Public for and in personally appeared: the

City of Bacolod, Negros Occidental, this 10th day of June, 2021, the
following appeared with her Tax Identification Numbers to wit;

ID Number DATE/PLACE
ISSUED
TAYLOR S. GOMEZ Tax Identification No. August 20, 1999/
389-837-298 Bacolod City

Known to me and to me known to be the same persons who executed the

foregoing instrument and acknowledged to me that the same are their free act and
voluntary deed.

This instrument, consisting of two (2) pages, including the page on which
this acknowledgment is written, has been signed on the left margin of each and
every page thereof by the concerned party, and sealed with my notarial seal.

WITNESS MY HAND AND SEAL on this 10th day of June 2021 at

Bacolod City, Negros Occidental, Philippines

ATTY. FRANZEIJAN A. NILLOS

Notary Public for Bacolod City
Notarial Commission No. 117
Until December 31, 2021
2/F ABC Bldg., Locsin-Lacson Sts.
Brgy. 13, Bacolod City, Negros Occidental
Roll No. 368081; April 19, 2017
IBP No. 902910; January 5, 2021,
PTR No. 711531; January 10, 2021,
MCLE Compliance VII-0004123; August 29, 2020
Office Tel. No. (034) 444-2261

Doc. No. 29;

Page No. 12;
Book No. 7;
Series of 2021.