REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC ) SS.

VERIFICATION AND
CERTIFICATION OF NON-FORUM SHOPPING

I, xxxxxx, of legal age, married, Filipino, and residing at 777 Virgo

Constellation Street, , Parañaque City after having been duly sworn to according
to law, hereby depose and state:

1. I am the Petitioner in the above captioned case.

2. I have caused the preparation of the foregoing Petition, and attest that
all contents and allegations therein are true and correct based on my own
personal knowledge and authentic records.

3. I have not commenced any other action or proceeding involving the

issues raised herein before this Honorable Court, the Supreme Court or different
divisions thereof, or any other tribunal or agency, and that to the best of my
knowledge, no such action or proceeding is pending before this Honorable
Court, the Supreme Court or different divisions thereof, the Court of Appeals or
any tribunal, agency or is pending therewith, and should I come to know of the
same, I undertake to inform the court accordingly within five (5) days.

IN WITNESS WHEREOF, I have hereunto affixed my signature below this

23rd day of March 2018 at Tarlac City, Philippines.

xxxx
Affiant
SSS No. 01-0000

SUBSCRIBED AND SWORN to before me this 23RD day of March 2018 at

Tarlac City, Philippines, affiant, whose identity is personally known to me, having
exhibited to me her valid identification card, the details of which is written below
his name.

Doc No. _____;

Page No.____;
Book No. ____;
Series of 2018.