Republic of the Philippines )

Miagao, Iloilo ) S.S.

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

VERIFICATION AND CERTIFICATION AGAINST

FORUM SHOPPING

I, NAME, Filipino citizen, of legal age, and with address at

[address], after having been duly sworn according to law, hereby
depose and state that:

1. I am the complainant in the above-entitled case and have

caused the preparation of this Complaint;

2. I attest that the allegations in this Complaint are true and

correct and based on my personal knowledge or based on
authentic records. My signature appearing herein serves as a
certification of the truthfulness of the allegations in this
Complaint;

3. I attest that this [pleading] is not filed to harass, cause

unnecessary delay, or needlessly increase the cost of litigation;

4. I attest that the factual allegations in this Complaint have

evidentiary support [or, after a reasonable opportunity for
discovery, will have evidentiary support];

5. I have not heretofore commenced any action or proceeding, nor

is there any action or proceeding, to the best of my personal
knowledge, pending in the Supreme Court, the Court of
Appeals, or in any other court, tribunal, or agency against the
same parties, involving the same cause; and

6. Should I hereafter learn that a similar action or proceeding has

been filed or is pending before the Supreme Court, the Court of
Appeals, or in any other court, tribunal, or agency, I undertake
to notify this Honorable Office within five calendar (5) days
therefrom.

IN WITNESS WHEREOF, I have affixed my signature this ____

day of January, 2020 at Miagao Iloilo.

NAME
 Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of

January, 2020 at Miagao, Iloilo, affiant personally appeared before me
and exhibited to me her competent evidence of identity, this being
__________________, containing her name, picture, and signature.

Doc No. ____

Page No. ____
Book No. _____
Series of 2020.