Republic of the Philippines

OFFICE OF THE CIVIL REGISTRAR GENERAL

National Statistics Office
Manila

Petitioner: __________________ Petition No. _____________

Title : _____________________________
Date : ____________________________

MOTION FOR RECONSIDERATION

I, LUZ PAMINTUAN-THEN, the petitioner, hereby appeal to the Civil Registrar

General to reconsider his/her decision in impugning the decision of CMR
_____________________________ who granted the petition for the
________________________________________________________________ in

a)  my _____________________
b)  The Certificate of Birth of __________________ THEN who is my SON.

and hereby respectfully aver that:

1. On ______________________, I received the decision of the above-named

CMR granting my petition. The above-mentioned decision of the CMR was
impugned by the CRG on ______________________ on the following
grounds:
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2. I received the copy of the CRG’s decision on __________________________.

WHEREFORE, I pray for the reversal of the CRG’s decision and for the
reconsideration of my motion of the following grounds:

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__________________________
 VERIFICATION

I, _____________________ the petitioner, hereby certify that the allegations

herein are true and correct to the best of my knowledge and belief.

________________________

Petitioner

SUBSCRIBED AND SWORN to before me this 5 th day of August, 2005 in the

City of San Fernando, Pampanga, petitioner exhibiting her Community Tax Certificate
No. 09202406 at Muntinlupa City on January 18, 2005.

Notary Public

Doc. No. ________

Page No. ________
Book No. ________
Series of 2005.

ACTION TAKEN BY THE CRG

/__/ Granted /__/ Denied

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Date: __________________________ __________________________

Civil Registrar General

Copy furnished:

CMR
CG
D/CR