Republic of the Philippines

REGIONAL TRIAL COURT

__________Judicial Region
Branch ____
________

IN RE: CANCELLATION OF
CERTIFICATE OF LIVE BIRTH
OF _________ WITH LOCAL
CIVIL REGISTRY NO. ______

_______________________________,
Petitioner,

– versus – SPL. PROC. Case No. _____

________________________________,
and the PHILIPPINE STATISTICS
AUTHORITY,
Respondents.
X--------------------------------------------X

PETITION

PETITIONER, by counsel, alleges:

1. Petitioner _____________________ (hereafter referred to

as “Petitioner” for brevity) is of legal age, ______________________,
__________ and a resident of Cairo, Egypt. At present, he is
temporarily residing at __________. A Copy of Petitioner’s Egyptian
Passport is hereto attached Annex “A” and made part hereof.

2. Petitioner may be served with orders, summons and

other court processes through the undersigned counsel with office
address at _________________, Philippines.

Respondent _____________________, with capacity to sue and be

sued and maybe served with summons at _____________________.
Respondents LOCAL CIVIL REGISTRAR of the __________________
and the PHILIPPINE STATISTICS AUTHORITY, are herein
impleaded as necessary party, both being the government agencies
that are tasked, inter alia, with the recording of the fact of births and
issuances of birth certificates, and other relevant data thereof, with
office address at _____________________, and Philippine Statistics
Authority, PSA Complex, East Avenue, Diliman, Quezon City,
respectively, where they may be served with summons and other
court processes.

3. Petitioner is the father of minor ____________ whose Birth

Certificate was falsified by ______________________ by causing it to
appear in the said Certificate of Live Birth which was entered in the
Local Civil Registrar’s Office _____ City that “_____________” was
born in _________________________ and that the attendant at birth is
a certain _________________.

4. The said Certificate of Live Birth with Registry No.

___________ bears the following information, to wit;

Name:
Birth Date:
Place of Birth:
Mother:
Father:
Attendant:
Remarks:

Copy of the said Certificate of Live Birth issued by Philippine

Statistics Authority is hereto attached as Annex “B” and is made an
integral part hereof.

5. That despite knowledge that minor, ________ was born in

Qatar and registered thereat, with a known Father, _______________
willfully and unlawfully caused the registration of the said Certificate
of Live Birth before the Local Civil Registrar’s Office of
_______________.

6. That upon knowing such fact, herein Petitioner executed

a Criminal Complaint for Falsification of Public Documents docketed
as Criminal Case No. ______ against ____________ and a separate
Criminal Case for Perjury against __________ docketed as Criminal
Case No. __________ for executing an Affidavit bearing untruthful
statements in order to support the delayed birth registration of
__________
 Copies of the Criminal Information is hereto attached as Annexes “C”
and “D” respectively and are made an integral part hereof.

7. That on June 28, 2019, the __________ of __________

rendered a Joint Sentence on the aforementioned criminal cases
finding __________ guilty for Falsification of Public Documents
specifically on the Birth Certificate of __________. Further,
__________ was also found guilty for the crime of Perjury in
executing an Affidavit stating untruthful claims relative to the birth
of __________.

A copy of the Joint Sentence is hereto attached as Annex “E” and is

made as an integral part hereof.

8. The existence of __________Birth Certificate at the records

of public respondent affects his identity given the fact that his true
birth information is that herein Petitioner is his Father; he was born
and registered in Qatar possessing Qatari Birth Certificate and
Residency Permit in the name of __________. Copy of __________ Birth
Certificate and Residency Permit are hereto attached as Annexes “F” and
“G”, respectively and made integral part hereof.

9. Herein Petitioner, as the Father of __________, now seeks

for the cancellation of the Certificate of Live Birth of __________
bearing registry No. __________from the records of Public
Respondent so as to put in order __________’s birth information and
identification, and to cancel the fraudulent Certificate of Live Birth
registered by __________without his knowledge and participation,
and for containing untruthful entries.

PRAYER

WHEREFORE, PREMISES CONSIDERED, IT IS MOST

RESPECTFULLY PRAYED OF THIS HONORABLE COURT, AFTER
NOTICE, DUE PUBLICATION AND HEARING, THAT AN ORDER
BE ISSUED DIRECTING THE OFFICE OF THE LOCAL CIVIL
REGISTRAR OF THE __________ AND PHILIPPINE STATISTICS
AUTHORITY, TO CANCEL THE CERTIFICATE OF LIVE BIRTH
BEARING REGISTRY NO. __________UNDER __________.

OTHER RELIEFS AS ARE JUST AND PROPER UNDER THE

CIRCUMSTANCES ARE LIKEWISE AND PRAYED FOR.

__________, August ____, 2019.

 VERIFICATION AND CERTIFICATE OF
NON-FORUM SHOPPING

I, __________, after having been duly sworn to in accordance with

law, hereby depose and state that:

1. I am the Petitioner in the above-captioned case for Petition for

the Cancellation of the Certificate of Live Birth of __________with
Registry No. __________;

2. In my capacity as such, I have caused the preparation of the

foregoing Petition, the contents of which are all true and correct on
my own personal knowledge and authentic records.

3. I have not theretofore commenced any action or filed any claim

involving the same issues in any court, tribunal or quasi-judicial
agency;

4. To the best of my knowledge, no such other action is pending

in any court, tribunal or quasi-judicial agency; and

5. If I should thereafter learn that the same or similar action or

claim has been filed or is pending, I shall report that fact within five
(5) days therefrom to the court wherein the aforesaid complaint or
initiatory pleading has been filed.

IN WITNESS WHEREOF, I hereunto affix my signature this ___th

day of ____________ 2019 at __________, Philippines.

Affiant
SUBSCRIBED AND SWORN TO, before me this th day

of July 2019 at __________, by the above affiant who is known to me,

and known to me personally to be the same person who executed the
foregoing Verification and Certificate of Non-Forum Shopping.
Affiant further exhibited to me, as competent proof of identity,
, pursuant to Rule 2, Section (a) of the 2004
Rules on Notarial Practice.

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