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PETITION FOR Clerical Errors First Name S

This document is a petition form from the Office of the City Civil Registrar in Davao del Norte, Philippines to correct clerical errors in a birth certificate. The petitioner, a Filipino resident of Davao del Norte, is seeking to correct the father's first name and informant's first name listed on their birth certificate. They explain that the name originally provided as the father's name was a nickname they used at the time rather than the legal name. Supporting documents including the birth certificate with errors, certificate of baptism, sibling's birth certificate and identification cards are submitted with the petition.

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210 views2 pages

PETITION FOR Clerical Errors First Name S

This document is a petition form from the Office of the City Civil Registrar in Davao del Norte, Philippines to correct clerical errors in a birth certificate. The petitioner, a Filipino resident of Davao del Norte, is seeking to correct the father's first name and informant's first name listed on their birth certificate. They explain that the name originally provided as the father's name was a nickname they used at the time rather than the legal name. Supporting documents including the birth certificate with errors, certificate of baptism, sibling's birth certificate and identification cards are submitted with the petition.

Uploaded by

lucy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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RA 9048 Form No. 4.

1 (C/MCRO)
(Revised 15 August 2001)
Republic of the Philippines
OFFICE OF THE CITY CIVIL REGISTRAR
Province of Davao del Norte
Municipality of Kapalong
Republic of the Philippines )
Municipality of Kapalong )s.s.
Province of Davao del Norte) Petition No. _____________

PETITION FOR CORRECTION OF CLERICAL ERROR


IN THE CERTIFICATE OF LIVE BIRTH

I, _ XXXXXXX _______________________, of legal age, _Filipino___________,


(complete name of petitioner) (nationality/citizenship)

and a resident of __ Davao del Norte ____________,


(Complete address)
after having been duly sworn to in accordance with the law, hereby declare that:

1. I am the petitioner seeking correction of the clerical error in :

My certificate of live birth

The certificate of live birth of _________XXXXXXXXXX _______________,


X
(complete name of the owner)
Who is my ________XXXXX________;
(relation of owner to the petitioner)
2. I/ He/ She was born on _2011 __ at _CCCCCC,_
(date of birth) (city/municipality)
________Davao del Norte_________________, ________Philippines____________________.
(province) (country)
3. The birth was recorded under Registry Number __VVVVVVVV_,
4. The clerical errors to be corrected are:

NO. ITEM NO. DESCRIPTION FROM TO

1 Father’s First Name


2 Informant’s First Name

5. The facts/reasons for filing this petition is because I supplied the name “JIV” I was using then
which was different from the name contained in my Certificate of Live Birth

6. I submit the following documents to support this petition: (use additional sheet if necessary)
a. PSA (previously NSO) Copy of the Certificate of Live Birth with errors;
b. Certificate of Baptism;
c. Certificate of Live Birth of sibling;
d. Voter’s Certification; and
e. Valid Identification Card of Philhealth;

7. I have not filed any similar petition and that, to the best of my knowledge, no other similar
petition is pending with any LCRO, Court of the Philippine Consulate.

8. I am filing this petition at the LCRO of Asuncion, Davao del Norte in accordance with R.A. No.
9048 and its implementing rules and regulations.
____ XXXXXXXXXX __ __
(Signature over printed name of petitioner)

VERIFICATION
I, ___ XXXXXX ___, the petitioner, hereby certify that the allegations herein are true and
correct to the best of my knowledge and belief.

XXXXXXXXXXX ___
(Signature over printed name of petitioner)

SUBSCRIBED AND SWORN to before me this _______ day of ________ in the city/municipality of
Kapalong, Davao del Norte petitioner exhibiting his PhilHealth identification card number 16-
025507400-5 issued at Kapalong, Davao del Norte.

For C/MCR use only

ACTION TAKEN BY THE C/MCR


(provide basis for the action taken)

Granted Denied
_______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Date _______________________ ____________________________


City / Municipality Civil
Registrar

For CRG use only

ACTION TAKEN BY THE C/MCR


(provide basis for the action taken)

Affirmed Impugned
_______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Date _______________________ ____________________________


City / Municipality Civil
Registrar
Payment of filing fee ( Please attached copy of the official receipt)
O.R No. __________________
Amount Paid ______________
Date Paid _________________

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