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Ref No.: _____________ NPC_LEO_CID_CAF-V1.0, R0.0, 05 April 2021
Floor, Philippine International Convention Center, Vicente Sotto Avenue, Pasay City, Metro Manila 1308
URL: https//www.privacy.gov.ph Email Add: email@example.com Tel No. 8234-2228
VERIFICATION AND CERTIFICATION
OF NON-FORUM SHOPPING
I, __________________________, Filipino, of legal age, and a resident of
having duly sworn to in accordance with law, do hereby depose and state:
1. The allegations in the complaint are true and correct based on my personal
knowledge, or based on authentic documents;
2. The complaint is not filed to harass, cause unnecessary delay, or needlessly
increase the cost of litigation;
3. The factual allegations therein have evidentiary support or, if specifically so
identified, will likewise have evidentiary support after a reasonable opportunity
4. That I further certify that (a) I have not commenced any action or filed any claim
involving the same issues in any court, tribunal or quasi-judicial agency and, to
the best of my knowledge, no such other action or claim is pending therein; (b) if
there is such other pending action or claim, a complete statement of the present
status thereof; and (c) if I should thereafter learn that the same or similar action or
claim has been filed or is pending, I shall report that fact within five (5) calendar
days therefrom to this Honorable Commission .
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of
___________ in __________________.
(Signature over Printed Name)
SUBSCRIBED AND SWORN to before me on this day of _________________,
affiant exhibiting to me his/her __________________ I.D. with No. ____________________
issued on _______________ at __________________ bearing his/her photo and signature.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2021.