{REPUBLIC OF THE PHILIPPINES }

{MARIVELES, BATAAN } S.S

VERIFICATION AND CERTIFICATION

I, ________________, Filipino, of legal age, married and presently residing

at __________________________________________, Philippines, after having
been sworn in accordance with the law do hereby depose and say:

1. That, I am the respondent in the above-mentioned administrative case;

2. That, I have caused this verified answer to be prepared;

3. That, the statements therein have evidentiary support (or will likewise have
evidentiary support after a reasonable opportunity for discovery); and

4. That, I read and understood its contents which are true and correct of my
own personal knowledge and/or based on authentic documents.

IN WITNESS WHEREOF, I have hereunto set out my hand this ____ day of
_______, 2022 at Mariveles, Bataan.

__________________________
Respondent

SUBSCRIBED AND SWORN to before me this ___ day of _________, 2022

at Mariveles, Bataan.

I hereby CERTIFY that I have personally examined the respondent and that I
am satisfied that he has voluntarily executed and understood this Verification
and Certification.