PETITIONER INFO FORM

ARE YOU SIGNING THIS PETITION AS (choose below):
IndividualOrganization

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Government-issued I.D.(required)
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I.D. no.

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Date of Issue (required)

VERIFICATION AND CERTIFICATION AGAINST FORUM SHOPPING

I/We, ENTER FULL NAME OF INDIVIDUAL or REPRESENTATIVES HERE, of legal age , do hereby state under oath that: I am one of the petitioners in this case and have, in that capacity, caused its preparation and filing; I have read all the allegations contained therein and affirm that they are all true and correct, and based on my own personal knowledge or on the basis of authentic records; I certify that I have not commenced any other action or proceeding involving the same issues in the Supreme Court, the Court of Appeals, or different Divisions thereof, or any other tribunal or agency; I further certify that to the best of my knowledge and belief, no such other action or proceeding involving the same issues is pending in the Supreme Court, the Court of Appeals, or different Divisions thereof, or any other tribunal or agency; I undertake that should I learn of any similar action or proceeding that has been filed or is pending before the Supreme Court, the Court of Appeals, or different Divisions thereof, or any other tribunal or agency, I shall notify the court within five (5) days from knowledge thereof.

SIGNED BY:

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