1 party
ACKNOWLEDGMENT
Republic of the Philippines )
City of Dumaguete )S.S.
SUBSCRIBED and SWORN to before me this ___ day of ___________, 2019,
personally appeared Affiants who are known to me and identified by me by competent pieces of
evidence of identities in accordance to the 2004 Rules on Notarial Practice. Affiants who
exhibited to me the above identification cards and who executed this foregoing instrument
acknowledged that the same is their free and voluntary act and deed.
IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal this
_____ day of _______, 2019 in Dumaguete City, Philippines.
Doc. No._____
Page No.____
Book No. ____
Series 2019.
2 or more parties
ACKNOWLEDGMENT
Republic of the Philippines )
City of Dumaguete )S.S.
SUBSCRIBED and SWORN to before me this ___ day of April, 2019, personally
appeared Affiant who is known to me and identified by me by competent evidence of identity in
accordance to the 2004 Rules on Notarial Practice. Affiant who exhibited to me the above
identification card and who executed this foregoing instrument acknowledged that the same is
their free and voluntary act and deed.
IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal this
_____ day of _____________, 2019 in Dumaguete City, Philippines.
Doc. No._____
Page No.____
Book No. ____
Series 2019.
JURAT
SUBSCRIBED and SWORN to before me in the City/Municipality of ______________,
this ______day of ___________, 2019 by NAME OF AFFIANT with IDENTIFICATION CARD
with IDENTIFICATION CARD NUMBER issued at ___________________, on,
__________________ and valid until ______________________
VERIFICATION
and
CERTIFICATION of NON-FORUM SHOPPING
I, NAME, Filipino, of legal age, and a resident of ADDRESS after having been duly
sworn to in accordance with law, do hereby depose and state:
1. That I am the Petitioner/Respondent in the above-entitled case;
2. That I have caused the preparation of the foregoing KIND OF INSTRUMENT, and
have read the contents thereof and affirm that the same are true and correct based on my
own personal knowledge and authentic documents;
3. That I have not commenced any other action or proceeding involving the same issues
as in the instant Complaint in the Supreme Court, the Court of Appeals or any other
tribunal or agency. To the best of my knowledge, no such action or proceeding is pending
before the Supreme Court, the Court of Appeals, or the different divisions thereof, or any
other tribunal or agency. If I should learn that a similar action or proceeding has been filed
or is pending before the Supreme Court, the Court of Appeals or the different divisions
thereof, or any other tribunal or agency, I undertake to inform this Honorable Office of
such fact within five (5) days from notice thereof.
Done this _____ day of __________ 2019, at Dumaguete City.
________________
Name of Affiant
Identification Card:
Identification No.
Issued at:
JOINT VERIFICATION
And
CERTIFICATION OF NON-FORUM SHOPPING
We, NAME OF AFFIANTS, both Filipino, of legal age, after having been duly
sworn to in accordance with law, do hereby depose and state:
1. That we are the Complainants/Respondents in the above-entitled case;
2. That we have caused the preparation of the foregoing KIND OF INSTRUMENT, and
have read the contents thereof and affirm that the same are true and correct based on
our own personal knowledge and authentic documents;
3. That we have not commenced any other action or proceeding involving the same issues
as in the instant Complaint in the Supreme Court, the Court of Appeals or any other
tribunal or agency. To the best of our knowledge, no such action or proceeding is
pending before the Supreme Court, the Court of Appeals, or the different divisions
thereof, or any other tribunal or agency. If we should learn that a similar action or
proceeding has been filed or is pending before the Supreme Court, the Court of Appeals
or the different divisions thereof, or any other tribunal or agency, I undertake to inform
this Honorable Office of such fact within five (5) days from notice thereof.
Done this ____ day of _________, 2019, at Dumaguete City.
___________________ ________________
NAME OF AFFIANT1 NAME OF AFFIANT2
Identification Card: Identification Card:
Identification No. Identification No.
Issued on/at: Issued at:
