VERIFICATION

I, ____________________, of legal age, Filipino and a resident of

_________City, Philippines, after having been duly sworn to in accordance with
law, depose and says that:
I am currently the _____________________, under the City Government
of ______.
That I have caused the preparation the foregoing document and that I
have read and know the contents of the same;
I hereby further attest that:
1. The reports contained therein are true and correct based of my own
personal knowledge and based upon authentic documents;

2. That the report is not filed to harass any party;

3. That the factual allegations therein have evidentiary support or , if

specifically identified will likewise have evidentiary support after
reasonable opportunity for discovery;

4. That I am executing this Affidavit to attest the truth of the foregoing

facts based from my own personal knowledge and authentic
documents.

IN WITNESS WHEREOF, I have hereunto SET MY HAND THIS

________________ at Bacolod City, Philippines.

______________________________
Affiant
ID no._______________

SUBSCRIBED AND SWORN to before me this ____________ at Bacolod

City, Philippines, Affiant is personally known to me to be the same person who
executed and signed this document exhibiting to me his competent proof of
identity on the date and place as indicated above.

NOTARY PUBLIC

Doc No ___
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Book No___
Series of 2022