CERTIFICATION OF NON-FORUM SHOPPING

REPUBLIC OF THE PHILIPPINES)

Province of____________________) S.S.

City/Municipality of_____________)

x---------------------------------------x

            I, ________________, of legal age, Filipino, (single / married / widow), and a resident of _______________, Philippines, after being sworn in accordance with law, hereby depose and certify that:

            (a) I have not thereto fore 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; (c) if I should thereafter learn that the same or similar action or proceeding has been filed or is pending before the Supreme Court, the Court of Appeals, or any other tribunal or quasi-judicial agency, I undertake to report such fact within five (5) days there from to the court or agency wherein the original pleading and sworn certification contemplated herein have been filed.

IN WITNESS WHEREOF, I have hereunto set my hands this _____________, at ______________, Philippines.

                                                                       AFFIANT

            SUBSCRIBED AND SWORN to before me, this _____________, by _____________ who exhibited to me (his/her) Community Tax Certificate No. _____________ issued at _____________, Philippines on ____________.

                                                                                    NOTARY PUBLIC

Doc. No.________;

Page No.________;

Book No.________;

Series No________;

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