Republic of the Philippines

REGIONAL TRIAL COURT

Seventh (7th) Judicial Region
Branch ___
Cebu City

IN THE MATTER OF ADOPTION OF THE MINOR AND PETITION FOR CHANGE

OF NAME
________

SP. PROC. NO.____

FOR: ADOPTION

SPOUSES
___________________________, Petitioners.

PETITION

PETITIONERS, through the undersigned counsel and to this Honorable Court, most
respectfully states, THAT:

1. Petitioners __________ and __________, are Filipinos, of legal age, married, and
residents of ___________;

2. Petitioners desire to adopt a minor, __ years of age whose present name is _______,
and a resident of ________________. Petitioners are more than sixteen 16 years
older than the minor they wish to adopt being now ___ years old

3. The names of the parents of the child are ________ and __________ both of
whom are now residing in ___________

4. The minor child has continuously resided with petitioners, his uncle and aunt since
he was 3 years old when his parents migrated to the ___________ to work

5. The petitioners are childless and are not disqualified by law to adopt the minor
because they are in full possession of all civil and legal rights; they have not been
convicted of any crime involving moral turpitude and are of good moral character
and in a financial position to support and care for the desired adoptee in keeping
with means of the family and has undergone pre-adoption services required of
Section 4 of Republic Act No. 8552. Likewise, the adoptee who has no estate is not
disqualified by law to be adopted;

6. The written duly notarized consent for the adoption of the adoptee by petitioner
which is authenticated before the Philippine Consular Office in Los Angeles,
California is hereto attached and made part hereof as Annex “A”;
 7. The home study report on the adoptee and his biological parents conducted by the
Department of Social Welfare and Development (DSWD) and a certificate from said
department on the petitioners as adopters and on the adoptee declaring the latter as
legally available for adoption are attached hereto and made part hereof as Annexes
“D” and “E” respectively;

8. The Birth Certificate as well as the baptismal certificate of the adoptee are attached
hereto and made part hereof as Annexes “D” and “E” respectively;

9. The adoption will serve the best interest and well-being of the child;

10. The adoptee shall be known and registered in the Civil Registry as _________ upon
the finality of the decree of adoption because ___________________

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed of this Honorable

Court that:

1. After due notice, publication and hearing, a Decree of Adoption of ____________

in favor of petitioner be rendered;

2. The name of the adoptee be ordered changed from ____________ to ___________

in the Civil Register; and

3. The said adoptee be declared free from all maintenance be declared free from all
maintenance with respect to his natural parents

Such other relief just and proper under the premises are likewise prayed for.

City of Cebu, Philippines, __ ______, 20__

__________________
Adopter

__________________
Adopter
Republic of the Philippines )
Cebu City ) S.S.

VERIFICATION/CERTIFICATION OF NON-FORUM SHOPPING

We, _____________ and ________________, of legal age, Filipino, married, and a resident
of _____________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That we are the adopters in the above-entitled petition and have caused this “Petition”
to be prepared, that I read and understood its contents which are true and correct of my
own personal knowledge and/or based on authentic records;

2. That I have not commenced any action of proceeding involving the same issue in the
Supreme Court, the Court of Appeals or any other tribunal or agency; that to the best of
my knowledge, no such action or proceeding is pending in the Supreme Court, the Court
of Appeals or any tribunal or agency; and that, if I should learn thereafter that a similar
action or proceeding has been filed or is pending before theses courts of tribunal or
agency, I undertake to report that fact to the Court within five (5) days therefrom.

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

____________, 20__

__________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of __________________, 20__

__________________
Notary Public
Address
Roll No.
IBP No.
MCLE Compliance
PTR Receipt

Doc No.
Page No.
Book No.
Series of 2019