Republic of the Philippines)

City of Baguio )S.S.

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VERIFICATION AND CERTIFICATION

That I, Juan dela Cruz, of legal age, Filipino, married and a resident of Baguio
City, after having been duly sworn to in accordance with law, hereby depose and
say:

That I am the petitioner in the above-entitled motion for appeal;

That I have caused the preparation of the foregoing petition;

That I have read the contents and the allegations therein contained are true
and correct to the best of my knowledge and belief;

I further certify that I have not theretofore commenced any similar action or
proceedings involving the same issue/s before any other tribunal including the
Supreme Court and Court of Appeals, or in any agency or instrumentality of the
government, to the best of my knowledge, no such action or proceeding is pending
before any other tribunal, including the Supreme Court or Court of Appeals, or in
any agency or instrumentality of the government, should I thereafter learn that a
similar action or proceeding has been filed or pending before the Supreme Court,
Court of Appeals or different divisions thereof, any tribunal, agency or
instrumentality of the government, I shall undertake to report such fact within five
(5) days therefrom to the Court or agency wherein the original pleadings and sworn
certification contemplated herein has been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this _______day of

September, 2011 at Baguio City.

Juan dela Cruz

Petitioner/Affiant
CTC No. _______________
Issued on ______________
At Paniqui, Tarlac

SUBSCRIBED AND SWORN to before me this __________day of

February, 2011 at Baguio City.