VERIFICATION

I, MAGDALENA M.R. LEPITEN, Filipino, of legal age, married and a resident of 33

Dapdap St., Mambaling, Cebu City, after being duly sworn to in accordance with law
hereby state:

1.

That I am the petitioner of the above instant case.

2.

That I have caused the preparation of the above-entitled petition.

3.
That I have read the same and that it is true and correct based on my personal
knowledge or based on authentic records.

4.

That I hereby certify under oath in this petition as follows:

a.
I have not theretofore commenced any action or filed any action or claim involving
the same issue in any court, tribunal or quasi-judicial agency and, to the best of my
knowledge, no such other pending action or claim is pending therein;
b.

If there is such other pending action or claim, a complete statement of the present
status thereof; and

c.

If I should thereafter learn that the same or similar action or claim has been filed or is
pending, I shall report that fact within five (5) days therefrom to the court wherein the
aforesaid complaint or initiatory pleading has been filed.

IN WITNESS WHEREOF, I have hereunto affixed my signature this , Cebu City,

Philippines.
ATTY. MAGDALENA M.R LEPITEN
CTC No.:11385970
Issued on Jan. 4, 2010
Issued at Cebu City

SUSBCRIBED AND SWORN TO before me, a notary in the Province and City of
Cebu, personally appeared above name with hers Community Tax Certificate Number as

shown above, who is personally known to me to be the same and/ or identified through
competent evidence of identity as defined by Rules on Notarial Practice, who presented the
foregoing instrument and signed the instrument in my presence, and who took an oath
before me as to such instrument.

Witness my hand and seal this Dec. 2, 2011

Doc. No.
Page No.
Book no.
Series of

PETITIONER MAGDALENA M.R. LEPITEN

SPECIMEN SIGNATURE

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THREE PASSPORT SIZE COLOR PHOTOGRAPHS

SIGNED AT THE BOTTOM BY PETITIONER