VERFICATION AND CERTIFICATION OF NON-FORUM SHOPPING
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF ____________ ) S.S
City/Municipality of ________)
X ---------------------------------------- X
I, _______, of legal age, Filipino, single, and a resident of _________, after being duly sworn in
accordance with law, hereby deposes and states that:
1.
2.
3.
4.
5.
I am the (Plaintiff, Complainant, Petitioner) in the above-entitled case;
I have caused the preparation of the above (Complaint/Petition);
I have read the same and knows the contents thereof;
The allegations contained therein are true and correct of my own personal knowledge.
I have further certify that:
a. I have not commenced any other action or proceeding or filed any claim involving the
same issues or matter in any court, tribunal, or quasi-judicial agency and, to the best of
my knowledge, no such action or proceeding is pending therein;
b. If I should learn that the same or similar action or proceeding has been filed or is
pending before the Supreme Court, Court of Appeals, or any other tribunal or quasijudicial agency;
c. I shall report that fact within Five (5) days to this Honorable Court.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________ at
__________________.
AFFIANT
SUBSCRIBED AND SWORN to before me this _______, by ____________ who exhibited to me
his/her ___________ issued at ____________ on ____________.
NOTARY PUBLIC
Doc No. ________;
Page No. _______;
Book No. _______;
Series of 2022
SPECIAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
I, __________, of legal age, Filipino, single and a resident of _____________ do hereby
appoint, name and constitute ___ATTORNEY-IN-FACT___, of legal age, Filipino, single and a
resident of __________ to be my true and lawful attorney-in-fact, for me and in my behalf, to do
and perform all or any of the following acts, deeds and things, to wit:
1. THINGS TO DO BY THE ATTORNEY IN FACT
HEREBY GIVING AND GRANTING unto my said Attorney-in-fact full power and authority
whatsoever necessary, proper or convenient as I might or could lawfully do if personally present
and hereby confirming and ratifying all that my Attorney-in-Fact shall lawfully do or cause to be
done by virtue of these presents.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ___________ at the
__________ Philippines.
PRINCIPAL (sgn)
ACCEPTED BY:
ATTORNEY-IN-FACT
SIGNED IN THE PRESENCE OF
_____________________________ ______________________________
ACKNOWLEDGEMENT
BEFORE ME, this ___________ day of _________________ at ____________ Philippines
personally appeared ____________________ and presented his/her with ____________ issued on
______________ at _______________, personally known to me or whom I have identified through
competent evidence of identity who executed the foregoing instrument and who acknowledged to me
that the same is their free act and deed.
This Instrument consists of only ______ (____) page/s, including this page in which
this acknowledgment is written, duly signed by _____________ and his/her instrumental witnesses
on each and every page hereof.
WITNESS MY HAND AND SEAL, this _________ at ___________________, Philippines
NOTARY PUBLIC
Doc No. __________
Page No. _________
Book No. _________
Series of 2022