VERIFICATION AND CERTIFICATION

OF NON-FORUM SHOPPING

I, ____________________, of legal age, Filipino, married and a

resident of _________________, on oath, hereby states that:

1. I am the Petitioner in the above-entitled case; that I have caused

the preparation of the foregoing petition; that I have read and understood
the contents thereof; and that all the allegations therein are true and correct
of my own knowledge and based on authentic records;

2. I have not commenced any other action or proceeding involving

the same issue in the Supreme Court, the Court of Appeals or any of its
divisions, or with any other tribunal or agency;

3. To the best of my knowledge, no such action or proceeding is

pending in the Supreme Court, the Court of Appeals or any of its divisions,
or with any other tribunal or agency;

4. If I should thereafter learn that a similar action or proceeding has

been filed or is pending in the Supreme Court the Court of Appeals or any
of its divisions, or with any other tribunal or agency, I undertake to promptly
inform this Honorable Court of the fact within five (5) days therefrom.

____________ City, Philippines.

IN WITNESS WHEREOF, I hereby set my hand this April 7, 2017 in

____________.

Affiant

SUBSCRIBED AND SWORN to before me this April 7, 2017, by

affiant who exhibited to me his ID No.____________, as proof of hisidentity.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.