RA 9048 Form No. 1.1.
(LCRO)
Republic of the Philippines
OFFICE OF THE CITY/MUNICIPAL CIVIL REGISTRAR
Province: ___________________
City/Municipality:________________
Republic of the Philippines )
______________________ ) S.S. Petition No. _____________
PETITION FOR CORRECTION OF CLERICAL ERROR
IN THE CERTIFICATE OF LIVE BIRTH
I, RONEL GILIG, of legal age, FILIPINO,
(complete name of petitioner) (nationality/citizenship)
and a resident of AGUS, LAPU-LAPU CITY, CEBU, PHILIPPINES
(complete address)
After having been sworn to in accordance with law, hereby declare that:
1) I am the petitioner seeking correction of the clerical error in:
a) my Certificate of Live Birth
b) the Certificate of Live Birth of ____________________________________
(complete name of owner)
who is my ________________________________________________
(relation of owner to the petitioner)
2) I/He/She was born on JULY 2, 1991 at LAPU-LAPU CITY.
(date of birth) (city/municipality)
3) The birth was recorded under registry number 2454.
4) The clerical error(s) to be corrected is (are)
Item No. Description From To
1 NAME (MIDDLE) MIANO
6 MAIDEN NAME (MIDDLE) TAGSEP
6 MAIDEN NAME (LAST) GILIG MIANO
5) The facts/reasons for filing this petition are the following: (Use additional sheets, if
neccessary.)
For Error No.1: inadvertence; erroneously marked.
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For Error No.2: inadvertence; erroneously marked.
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For Error No.3: inadvertence; erroneously marked.
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For Error No.4: _________________________________________________________
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6) I submit the following documents to support this petition (Use additional sheets, if
necessary.)
a) PSA Certificate of Live Birth
b) PSA Certificate of Marriage of Parents of Petitioner
c) PSA Certificate of Live Birth of Parents
d) ____________________________________________________________________
7) I have/He/She has not filed any similar petition and that to the best of my knowledge, no
other similar petition is pending with any LCRO, Court or Philippine Consulate.
8) I am filing this petition at the LCRO of LAPU-LAPU CITY, CEBU
(city/municipality) (province)
in accordance with R.A. No. 9048 and its implementing rules and regulations.
RONEL GILIG
Signature over printed name of petitioner
VERIFICATION
I, RONEL GILIG, the petitioner, hereby certify that the allegation Herein are true and
correct to the best of my knowledge and belief.
RONEL GILIG
Signature over printed name of petitioner
SUBSCRIBED AND SWORN to before me this _____ day of _____________________
in the city/municipality of ____________________________, petitioner exhibiting to me his/her
__________________________ as competent proof of identity.
_________________________
Administering Officer
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.
For C/MCR use only
ACTION TAKEN BY THE C/MCR
Granted Denied (Provide basis for denial)
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Date: ________ ___________________________
City/Municipal Civil Registrar
For CRG use only
ACTION TAKEN BY THE CRG
Affirmed Impugned
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Date: ____________ _______________________
City Registrar General
OR No.: _________________________
Amount Paid: _____________________
Date Paid: ________________________
