Verification and Certification

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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC )SS.

VERIFICATION AND
CERTIFICATION OF NON-FORUM SHOPPING

I, _________________, Filipino, of legal age, single, and a


resident of ___________________ City, Philippines, after being sworn
in accordance with law, depose and state:

1. I am the Plaintiff in the foregoing Complaint and have caused the


preparation and filing of the same;

2. That the allegations in the Complaint are true and correct based
on my personal knowledge, or based on authentic documents;

3. That the pleading is not filed to harass cause unnecessary delay,


or needlessly increase the cost of litigation;

4. That the factual allegations therein have evidentiary support or,


if specifically so identified, will likewise have evidentiary support
after a reasonable opportunity for discovery.

5. That I have not theretofore commenced any action or filed any


claim involving the same issues in any court, tribunal or quasi-
judicial agency and, to the best of my knowledge, no such other
action or claim is pending therein;

6. That if there is such other pending action or claim, a complete


statement of the present status thereof; and

7. That 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) calendar days therefrom to the court wherein I
aforesaid complaint or initiatory pleading has been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this


____ of __________ 2020 at ________________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of


_________ 2020 at ___________, Philippines, affiant whose identity
is personally known to me, having exhibited his/her ID
___________________ as competent proof of identity.

____________________
Administering Officer

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