VERIFICATION WITH

CERTIFICATION OF NON-FORUM SHOPPING

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

resident of Bacolod City, being duly sworn to, in accordance with law, hereby
deposes and states that:

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

caused the foregoing Complaint to be prepared and filed;

2. I have read and understood its contents which are true and
correct of my own personal knowledge and/or based on authentic
records;

3. I have not commenced any action or proceeding involving the

same issue with the Supreme Court, the Court of Appeals or any other
tribunal or agency; that to the best of my knowledge, no such action or
proceeding is pending in the Supreme Court, the Court of Appeals or
any other tribunal or agency, and that, if we should learn thereafter
that a similar action or proceeding has been filed or is pending before
any of the said courts, tribunal or agency, I undertake to report that fact
to the Honorable Office within five (5) days from notice therefrom.

IN TRUTH AND WITNESS WHEREOF, I hereunto set my hand this 16

November 2017 in Bacolod City, Philippines.

___________________
Affiant
Gov’t issued I.D. No.: ___________

SUBSCRIBED AND SWORN TO BEFORE ME, for and in the City of Bacolod,
this ___________, Affiant who is personally known to me and to me known to be
the same person, personally appeared to me and signed the foregoing as noted
above.

Witness my hand and seal.

Doc. No. ______;

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