Certification of Forum Non-Shopping

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VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I, F, of legal age, married, Filipino and a resident of Barangay 100, Dumaguete City,
after being sworn according to law, hereby depose and state that;

1. I am the plaintiff in the above-stated case;

2. I caused the preparation of the foregoing complaint;

3. I have read the contents thereof and the facts stated therein are true and correct of
my personal knowledge and/or on the basis of copies of documents and records in
my possession;

4. I have not commenced any other action or proceeding involving the same issues
in the Supreme Court, the Court of Appeals, or any other tribunal or agency;

5. To the best of my knowledge and belief, no such action or proceeding is pending


in the Supreme Court, the Court of Appeals, or any other tribunal or agency;

6. If I should thereafter learn that a similar action or proceeding has been filed or is
pending before the Supreme Court, the Court of Appeals, or any other tribunal or
agency, I undertake to report that fact within five (5) days therefrom to this
Honorable Court.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7 th day of January


2022, at Dumaguete City, Philippines.

F
Affiant

SUBSCRIBED AND SWORN to before me this 7 th day of January 2022, at Dumaguete


City, affiant exhibiting to me her Unified Multipurpose ID with No. 12345678 issued on
May 15, 2018 at SSS, Dumaguete City, as competent proof of her identity.

______________
Notary Public
Valid until December 31, 2022
Roll of Attorney No. 1234
IBP No. 123456
PTR No. 12345/01-01-19
MCLE Compliance No. 12345/12-01-22
Dumaguete City, Philippines

Doc. No. ____________;


Page No. ___________;
Book No. ___________;
Series of 2022.

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