REPUBLIC OF THE PHILIPPINES}}

PAGADIAN CITY }} SS

VERIFICATION AND CERTIFICATION

I, _________, of legal age, married and a resident of Pagadian City, do hereby depose
and say that:

1. I executed the said pleading and caused the preparation hereof;

2. I have read the contents thereof and same are true and correct and based on my
personal knowledge, or based on authentic documents;
3. The pleading is not filed to harass, cause unnecessary delay and needlessly increase the
cost of litigation; and
4. The factual allegations therein have evidentiary support or if specifically so identified,
will likewise have evidentiary support after a reasonable opportunity for discovery.
5. I have not theretofore commenced any action or filed any claim involving the same
issues in any court, tribunal or quasi-judicial agency and, to the best of my knowledge, no
such other 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 should I thereafter learn
that the same or similar action or claim has been filed or is pending, I shall report that
fact within five (5) calendar days therefrom to the court wherein this aforesaid complaint
or initiatory pleading has been filed.

IN WITNESS HEREOF, I have hereunto signed this instrument this _____ day of June,
2022 in Pagadian City, Philippines.

(FULL SIGNATURE OVER PRINTED NAME)

Affiant

JURAT

SUBSCRIBED AND SWORN TO before me a notary public of Pagadian City,this ____

day of June, 2022, the affiant exhbiting to me his (competent proof of identity) issued by
(agency) issued at (place of issuance and issued on _____ day of June, 2022. The affiant
theretofore is known to me and to me known to be the same person who executed the
foregoing Verification and Certification.

Notary Public

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