REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU) S.S

VERIFICATION AND CERTIFICATION AGAINST NON-FORUM SHOPPING

I, JUAN DELA CRUZ, of legal age, Filipino, single, and a resident of Barangay Bonbon,
Cebu City, after having been duly sworn in accordance with law, depose and state that:
1. I am a plaintiff 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 Court.
IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day of April,
2023.

JUAN DELA CRUZ

Affiant t

SUBSCRIBED AND SWORN to before me this 20 th day of April 2023 at Banilad, Cebu City
affiant exhibiting to me his Government ID No. 123456789 issued on April 12, 2022 at
Banilad, Cebu City.

ATTY. GILBERT BLYTHE

Notary Public
Commission No. 2019-0001
Until December 31, 2023
ROLL No. 87654- March 13, 2001
IBP O.R.No. 3828 / LIFE
PTR No. 12345670 –January 02, 2023
BOTH ISSUED IN CEBU CITY
Doc. No. 3480 ;
Page No. 456 ;
Book No. IV ;
Series of 2023