VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, _____________, of legal age, with office address at _________________,

after having been sworn according to law, hereby depose and state that:

1. I am the Petitioner in the above-captioned case, and I caused the preparation of

the foregoing Petition;

2. I also attest that:

2.1 All the allegations therein are true and correct of my own personal
knowledge and based on authentic documents.

2.2 This Petition is not filed to harass, cause unnecessary delay, or

needlessly increase the cost of litigation.

2.3 The factual allegations therein have evidentiary support or, if specifically
so identified, will likewise have evidentiary support after a reasonable
opportunity for discovery.

3. And, I hereby certify, that:

3.1 I have not, commenced any other action or proceeding involving the same
issues in the Supreme Court, the Court of Appeals, or different Divisions
hereof, or any other tribunal or agency other than the one mentioned in the
Petition herein;

3.2 To the best of my knowledge, no such action or proceeding involving the

same issues is pending thereat.

3.3 If I should thereafter learn that a similar action or proceeding has been
filed or is pending in the Supreme Court, Court of Appeals or any other
tribunal or agency. I undertake to report that fact within five (5) days therefrom
to the court or agency wherein the original pleading and sworn certification
contemplated have been filed.

IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of

____________ 2022 at ____________________.

________________
Affiant
Republic of the Philippines }
} S.S.

SUBSCRIBED AND SWORN TO before me this ___________ th day of

__________________ at __________________ affiant exhibiting to me the document entitled
“Verification” and presenting competent evidence of his identity which is his/her _________ ID No.
___________ issued on __________ at _________________ which contains her picture. Affiant
signed the “Verification” in my presence and has taken her oath before me as to the instrument.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2022.