REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

x----------------------------x

VERIFICATION/CERTIFICATION OF
NON-FORUM SHOPPING

I, ______________________, of legal age, _______, Filipino, and a

resident of _________________________________________, Philippines, after
having been duly sworn to in accordance with law hereby depose and
say:

1. That I am the Petitioner in the above-captioned case;

2. That I have read and caused the preparation of the

foregoing Petition and that all the allegations contained therein
are true and correct of my personal knowledge or based on
authentic records;

3. That I have not commenced any other action or proceedings

involving the same issues in the Supreme Court, Court of
Appeals or any other tribunal or agency, and to the best of
my knowledge, no such action or proceeding is pending before
the Supreme Court, the Court of Appeals or other tribunal or
agency;

4. That if I should hereafter learn that a similar action or

proceeding has been filed or is pending in the Supreme Court,
Court of Appeals, or any other tribunal or agency, I undertake
to report such fact within five (5) days therefrom to the court
or agency wherein the original pleading or sworn certification
contemplated herein has been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this _____

day of ______________ 2019 in the City of ______________, Philippines.

_________________________
Affiant
ID No. 703-581-318-000
Issued by: BIR

SUBSCRIBED AND SWORN TO before me, a Notary Public for and

in the City and Province of Iloilo, this ______ day of _______________ 2019
in the City of __________________, Philippines, affiant appeared with his
I.D. No. listed below his name above whose personally known to be the
same person to the Notary Public or identified by the Notary Public
through competent evidence of identity as defined by the 2004 Rules
on Notarial Practice pursuant to Supreme Court EN BANC A.M No. 02-8-
13 SC Resolution. That the herein person represented to the Notary
Public that the signature on the instrument or document was
voluntarily affixed by him.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2019.