Civil Registrar Form

REPUBLIC OF THE PHILIPPINES)
PROVINCE OF CEBU )SS

Municipality of ________________)
Registry No. 2004
AFFIDAVIT TO USE THE SURNAME OF THE FATHER
I, __________________, of legal age, Filipino, and a resident of

_________________, after having been duly sworn to in accordance with law, do hereby
declare that:
1. I am seeking the use of the surname ____________________ in;

a) / / my certificate of live Birth/report of Birth, pursuant to R.A.No.9255.
b) / / the Certificate of Live Birth/Report of birth of _______________________
(Complete name child)
Who is my , pursuant to R.A. 9255
(Relation of affiant to child)
2. I/He/She was born on at ________________, _________,
(Date of birth) (Municipality) (City)
___________________
(Country)
3. The birth was recorded under Registry No. __________ on _____________ at the
4. The public document was recorded under Registry No. _______________ on
____________ at the LCRO of _____________________(If applicable)
5. I/The father have/has sought the consent of my /the child as shown by his/her
consent. (Applicable only if the child is 18 years old and above; Not applicable if
child is the affiant)
6. In support hereof, I submit the attached private handwritten instrument including
the following supporting documents.
A.)________________________________
B.)________________________________
7. I am filling this affidavit at the LCRO of _________________________, in
accordance with R.A. 9255 and it’s implementing Rules and Regulation.
8. I hereby that the statements made herein are true and correct to the best of my
knowledge and belief.
9. in truth whereof, I have hereunto affixed my signature this _______ day of
__________, _______.
_____________________________________________________________________
_____________________________
(Signature over printed name of Affiant)
SUBSCRIBED AND SWORN TO before me this ___ day of ______________ in

the city/municipality of ___________, affiant exhibiting his community Tax Certificate
No. ________________ issued at _________________ on _________________.
PROVINCE OF CEBU ) SS
Registry No. 2005
AFFIDAVIT OF ACKNOWLEDGMENT
I, LEOPOLDO B. FAMADOR, of legal age, Filipino and presently residing at

1137 Andres Abellana Ext., Province of Cebu, after having duly sworn to in accordance
with law hereby depose and say:
1. I am the natural father of JEERICO BASILES who was born on August 24,
1997, at Cebu Puer. Center & Maternity House, Inc., Cebu Philippines.
2. His/Her mother is Claudia B. Famador who is my common-law wife.
3. I am executing this affidavit to attest to the truthfulness of the foregoing

statement and for the purposes of acknowledging my child.
In truth whereof, I have hereunto affixed my signature this day of _________, the
City of Cebu, Philippines.
LEOPOLDO B. FAMADOR
Affiant
SUBSCRIBED AND SWORN TO before me this day of ____________ at Cebu

City, Philippines.
RA 9048 Form No. 1.1 (LCRO)
Revised 17 August 2001
Republic of the Philippines

OFFICE OF THE LOCAL CIVIL REGISTRAR
Province of Cebu
Municipality of Alegria
Republic of the Philippines)
Municipality of Alegria ) ss Petition no. ______________
PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH
I, VICTORIA E. DICDICAN , of legal age, married, and a resident of
Compostela, Cebu, after having been duly sworn to in accordance with law, do hereby declared
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 VICTORIINO A, DICDICAN .

(Complete name of owner)
who is my husband.
2. He was born on May 16, 1951 at Madridejos, Alegria .

(Date of birth) (City/municipality)
Province of Cebu _____, Philippines .

(Province) (Country)
3) The birth was recorded under registry number 142 .
4) The Clerical error(s) to be corrected is (are): (Use additional sheets. if necessary)
Item No. Description From To

First name of child VICTORIO VICTORINO
5) The facts/reasons for filing this petition are the following. (Use additional sheets. if
necessary)
a. The correction will avoid confusion .
6) I submit the following documents to support this petition. (Use additional sheets. if
necessary).
a) Marriage Contract of my husband marked as Annex “A” .

b) Birth Certificate of my son *Joevic Jed” marked as Annex “B” .
c) Birth Certificate of my son “Victorino Jr.” Annex “C” .
d) Birth Certificate of my son “Jurlan” marked as Annex “D” .
7) I have not filed any similar petition and that, to the best of knowledge, no other
similar petition is pending with the LCRO, Court or Philippine Consulate.
8) I am filing this petition at the LCR of Alegria , Province of Cebu .

(City/municipality) (Province)
In accordance with RA No. 9048 and its implementing rules and regulations.
VICTORIA E. DIDICAN .
Signature over printed name of petitioner
Petition,
Second page . . . . /
VERIFICATION
I, VICTORIA E. DICDICAN , the petitioner, hereby certify that the

allegations herein are true and correct to the best of my knowledge and belief.
VICTORIA E. DICDICAN .
SUBSCRIBED AND SWORN TO BEFORE ME this ____________________, in the City of

Cebu, Philippines, petitioner exhibiting her Com. Tax Cert. No.15822211, issued on Feb. 13,
2008, at Compostela, Cebu.
Doc. No. _____ ____________________________________

Page No. _____ Administering Officer
Book No. _____
Series of _____
---------------------------------------------------------------------------------------------------------------------
For C/MCR use only
ACTION TAKEN BY THE C/MCR
Granted Denied (Basis for denial provided below)
Date: ________________ __________________________

City/Municipal Civil Registrar
Payment of filing fee (Please attached copy of the official receipt)
O.R. No. ______________

Amount paid ______________
Date Paid ______________
Province of Cebu
Municipality of Oslob, Cebu
Republic of the Philippines )

Municipality of Oslob, Cebu ) ss Petition no. ______________
PETITION FOR CHANGE OF FIRST NAME

I, IRENE M. BACOLOD-LACUÑA , of legal age, married, Filipino, and a resident
of Barangay Gawi, Oslob, Cebu City, after having been duly sworn to in accordance with law,
do hereby declared that:
1) I am the petitioner seeking the change of name in:
a) My Certificate of Live Birth.
b) The Certificate of Live Birth of _____________________________

Who is my son?
2. I/he was born on Jan. 1, 1969 at Kaongkod, Madredejos .

Province of Cebu _____ , Philippines .

3) The birth was recorded under registry number 172 .
4) The first name to be change is from ERENE to IRENE .
necessary)
a) The first name is extremely difficult to write or pronounce

b) I/He/She have/ has been habitually and continuously used the name MA.SALOME
and I/he/she am/is publicly known in the community which that first name;
c) The first name is tainted with dishonor.
d) The first name is ridiculous;
e) The first name causes confusion;
f) Others (Specify) _______________________________________________________
necessary).
a) PhilHealth Card marked as Annex “A” .

b) Commission on Election (COMELEC) identification card marked as Annex “B” .
c) Barangays of Oslob Waterworks & Sanitation Service Cooperative (BOWSCO)
identification (ID) Card marked Annex “C” .
8) I have no pending criminal, civil, or administrative case in any court or any quasi
judicial body.
9) I am filing this petition at the LCRP of Oslob, Cebu , Province of Cebu .

in accordance with RA No. 9048 and its implementing rules and regulations.
IRENE M. BACOLOD-LACUÑA .
RA 9048 Form No. 7 (OCR G)

OFFICE OF THE CIVIL REGISTRAR GENERAL
National Statistics Office
Manila
Petitioner: JESUS L. LIBATON JR. Petition No. CCE-003-2005

Title : Petition for Correction of Clerical Error
Date : August 8, 2005
MOTION FOR RECONSIDERATION
I, JESUS L. LIBATON Jr., the petitioner, hereby appeal to the Civil Registrar
(Complete name of petitioner)
General to reconsider his decision in impugning the decision of C/MCR CHONA E. TA-
(Complete name of
C/MCR)
AS, who granted the petition for the correction of clerical error in
(Type and nature of the petition)
a) My Certificate of Live Birth .
(type of document)
b) The __________________________ of
______________________
(type of document)
Who is my ____________________________
(Relation of owner to the petitioner)
And hereby respectfully aver that:
1. On February 14, 2005 , the above-named C/MCR granted my petition for

(Complete date)
Correction of clerical error in my Certificate of Live Birth. However, the above-
mentioned decision of the C/MCR was impugned by the CRG on March 15, 2005, on the
following grounds:
__________________________________________________________________
____That the petition was posted prior to the acceptance of the verified petition__
__________________________________________________________________
__________________________________________________________________
2. I received the copy of the CRG’s decision on August 8, 2005 .
WHEREFORE, I pray for the reversal of the CRG’s decision and for the
reconsideration of my petition on the following grounds:
____Although, it appeared from the jurat that the said petition was subscribed by
petitioner on January 17, 2005, but, the truth, however, the verified petition was actually
subscribed by petitioner on January 7, 2005. The date “17 th”, was only a typographical
error in the preparation of the said petition as the notarial register of Notary Public,
Attorney Ronald L. Guaren, showed that the said petition was verified on the 7 th of
January 2005. As a matter of fact, the said notary public had executed an affidavit
attesting that the subject petition was subscribed before him on the 7 th day of January
2005, and not on the 17th day of January 2005. The affidavit of Atty. Ronald L. Guaren is
hereto attached and marked as Annex “A” and made an integral part of this motion .
__ JESUS L. LIBATON JR. ____
Signature over printed name of
petitioner
CITY OF CEBU ) ss
X - - - - - - - - - - - - - - -- - - - - - - /
AF IDAVIT
I, RONALD L. GUAREN, of legal age, married, Filipino, and residing at

Barangay Lagundi, Oslob, Cebu, after having been duly sworn to in accordance with law,
do hereby depose and say:
That I am duly commissioned by the Regional Trial Court of Cebu City to

notarize documents;
That my commission is valid until December 31, 2006;
That sometime on January 7, 2005, I happened to notarize a document known as

petition for correction of clerical error in the Certificate of Liver Birth of Jesus L.
Libaton, Jr.;
That the said document was registered in my notarial register under Doc. No. 86,
Page No. 19, Book No. 17, Series of 2005. A copy of page no. 19, of my notarial register
is hereto attached and marked as Annex “A-1”;
That, however, in the verification of the said petition, it was erroneously entered
that that the petition was subscribed before me by the petitioner, Jesus L. Libaton, Jr., on
January 17, 2005, instead of January 7, 2005;
That, as can be shown in my notarial register, the subject petition was actually
subscribed on the of 7th day of January 2005, and not on the 17 th day of January 2005,
and thus, I therefore honestly believe that that entry “17 th” was only a mere typographical
error in the preparation of the said petition;
That, in view thereof, I am executing this affidavit to attest the fact that the
petition for correction of clerical error in the Certificate of Live Birth of Jesus L. Libaton,
Jr., was actually subscribed before me by petitioner, Jesus L. Libaton, Jr., on the 7 th day
of January 2005, and not on the 17th day of January 2005, as erroneously entered therein.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 8 th day of

August 2005, in the City of Cebu, Philippines.
RONALD L GUAREN
Affiant
SUBSCRIBED AND SWORN to before me this 8 th day of August 2005, in the

City of Philippines. Affiant exhibiting to me Com. Tax Cert. No. 080825337, issued on
Jan. 25, 2005, in the City of Cebu, Philippines.
Doc. No. ____ RIO C. BILOCURA

Page No. ____ Notary Public
Book No. ___ Until December 31, 2005
Series of 2005 PTR No. 7391351
January 7, 2005, Cebu City
CITY OF CEBU ) ss
X - - - - - - - - - - - - - - -- - - - - - - - /
A FF I DAV IT OF AUTHORIZATION AND CONSENT
I, VICTORIA E. DICDICAN, of legal age, married, Filipino, and residing in

Compostela,, Cebu, after having been duly sworn to in accordance with law, do hereby
depose and say:
That I am the wife of VICTORIO DICDICAN (also known as VICTORINO

DICDICAN) who is now working in Iceland;
That I and my husband, Victorio Dicdican, have two (2) minor children namely
Victorino Dicdican Jr. and Jonalyn Dicdican;
That my husband, Victorio Dicdican, is applying for immigrant visa for me and
my children including the two (2) minors in Iceland;
That, considering that my authorization and consent is required before my

husband can file an application and process the immigrant visa for my two (2) minor
children, I am executing this affidavit of authorization and consent to express and
manifest the fact that I have authorized and gave my consent unto my husband, Victorio
Dicdican to file an application and process the immigrant visa for my two (2) children
namely, Victorino Jr. and Jonalyn Dicdican;
That I further sayeth naught.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 22nd day of

February 2008, in the City of Cebu, Philippines.
VICTORIA E. DICDICAN
Affiant
SUBSCRIBED AND SWORN to before me this 22nd day of February 2008, in

the City of Philippines. Affiant exhibiting to me Com. Tax Cert. No. 15822211, issued on
Feb. 13, 2008, in the City of Cebu, Philippines.
Doc. No. ____ RONALD L. GUAREN

Page No. ____ Notary Public
Book No. ___ Until December 31, 2008
Series of 2008 PTR No. 1712716
January 3, 2008, Cebu City

Province of Negros Oriental
Municipality of Basay
Municipality of Basay ) ss Petition no. ______________

I, TITO JAUDIAN ASOLA , of legal age, married, and a resident of Calumpang,
Oslob, Cebu, after having been duly sworn to in accordance with law, do hereby declared that:
a) my Certificate of Live Birth ____________________________________________.
b) the Certificate of Live Birth of __________________ .

who is my _________________________________________________________________.
2. I was born on __ December 9, 1957 at _________ Basay .

Province of Negros Oriental____ , Philippines .

3) The birth was recorded under registry number 92 - 231 .
4) The Clerical error (s) to be corrected is (are): (Use additional sheets. if necessary)

1 Last name of child AZULA ASOLA
9 Last name of father AZULA ASOLA
necessary)
The correction will avoid confusion .

__________________________________________________________________________
necessary).
a) Baptismal Certificate of petitioner marked as Annex “A” .

b) Birth Certificate of my daughter (Chilica Asola) marked as Annex “B” .
c) Birth Certificate of my son (Melvin Asola) marked as Annex “C” .
d) Birth Certificate of my father (Jesus Asola) marked as Annex”D” .
8) I am filing this petition at the LCRP of Basay , Negros Oriental .

TITO J. ASOLA .


Republic of the Philippines)

a) My Certificate of Live Birth ____________________________________________.
b) The Certificate of Live Birth of ______MARLITO L.

ASOLA .
Who is my _______________________son______________________________________.
2. He was born on _ May 15, 1984 at _________ Basay .



3 Last name of child ASULA ASOLA
6 First name of mother LORENSA LORENZA
13 Last name of father ASULA ASOLA
necessary)

__________________________________________________________________________
necessary).

b) Birth Certificate of my daughter (Chilica Asola) marked as Annex “B” .
c) Birth Certificate of my son (Melvin Asola) marked as Annex “C” .
d) Birth Certificate of my wife (Lorenza Lirasan) marked as Annex”D” .

TITO J. ASOLA .



a) My Certificate of Live Birth ____________________________________________.
b) the Certificate of Live Birth of _____

LERASOL L. ASOLA .
(complete name of owner)
who is my _______________________son______________________________________.
2. He was born on _ July 4, 1982 at _________ Basay .

(Date of birth) (city/municipality)


3 Last name of child AZOLA ASOLA
3 Middle name of child LERASAN LIRASAN
7 Last name of father AZOLA ASOLA
12 Last name of mother LERASAN LIRASAN
necessary)

__________________________________________________________________________
necessary).

b) Baptismal Certificate of the child marked as Annex “B” .
c) Birth Certificate of my wife (Lorenza Lirasan) marked as Annex “C” .
d) Birth Certificate of my daughter (Chilica Asola) marked as Annex”D” .
e) Birth Certificate of my son (Melvin Asola) marked as Annex “E”.

(city/municipality) (province)
TITO J. ASOLA .

CITIES AND PROVINCE OF CEBU)S.S.
SWORN STATEMENT
I, GLORIA S. TUMULAK, hereby certify under oath that I have actually

enrolled in the school listed in the accompanying transcript of records and that
I have actually earned the units indicated therein.
As required, the Department of Education, Region VII, Central Visayas,
DIVISION OF CEBU has been furnished with authenticated copies of the Sworn
Statement and its enclosure/s.
GLORIA S. TUMULAK
Affiant
SUBSCRIBED AND SWORN TO before me this ___day of ______________,

2006. Affiant exhibited to me her Community Tax Certificate No. 00636979
issued at Pasil, Santander, Cebu on March 6, 2006.

CITIES AND PROVINCE OF CEBU)S.S.
SWORN STATEMENT
I, BABY AGAPITA C. VASQUEZ, hereby certify under oath that I have

actually enrolled in the school listed in the accompanying transcript of records
and that I have actually earned the units indicated therein.
As required, the Department of Education, Region VII, Central Visayas,
DIVISION OF CEBU has been furnished with authenticated copies of the Sworn
Statement and its enclosure/s.
BABY AGAPITA C. VASQUEZ

Affiant
SUBSCRIBED AND SWORN TO before me this ___day of ______________,

2006. Affiant exhibited to me her Community Tax Certificate No. 00636976
issued at Santander, Cebu on March 6, 2006.

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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CEBU )SS

AFFIDAVIT TO USE THE SURNAME OF THE FATHER

I, __________________, of legal age, Filipino, and a resident of

1. I am seeking the use of the surname ____________________ in;

SUBSCRIBED AND SWORN TO before me this ___ day of ______________ in

Registry No. 2005

I, LEOPOLDO B. FAMADOR, of legal age, Filipino and presently residing at

2. His/Her mother is Claudia B. Famador who is my common-law wife.

3. I am executing this affidavit to attest to the truthfulness of the foregoing

SUBSCRIBED AND SWORN TO before me this day of ____________ at Cebu

Republic of the Philippines

PETITION FOR CORRECTION OF CLERICAL ERROR

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 VICTORIINO A, DICDICAN .

2. He was born on May 16, 1951 at Madridejos, Alegria .

Province of Cebu _____, Philippines .

3) The birth was recorded under registry number 142 .

4) The Clerical error(s) to be corrected is (are): (Use additional sheets. if necessary)

Item No. Description From To

a. The correction will avoid confusion .

a) Marriage Contract of my husband marked as Annex “A” .

8) I am filing this petition at the LCR of Alegria , Province of Cebu .

I, VICTORIA E. DICDICAN , the petitioner, hereby certify that the

SUBSCRIBED AND SWORN TO BEFORE ME this ____________________, in the City of

Doc. No. _____ ____________________________________

ACTION TAKEN BY THE C/MCR

Granted Denied (Basis for denial provided below)

Date: ________________ __________________________

Payment of filing fee (Please attached copy of the official receipt)

O.R. No. ______________

Republic of the Philippines )

PETITION FOR CHANGE OF FIRST NAME

1) I am the petitioner seeking the change of name in:

a) My Certificate of Live Birth.

b) The Certificate of Live Birth of _____________________________

2. I/he was born on Jan. 1, 1969 at Kaongkod, Madredejos .

Province of Cebu _____ , Philippines .

3) The birth was recorded under registry number 172 .

4) The first name to be change is from ERENE to IRENE .

a) The first name is extremely difficult to write or pronounce

a) PhilHealth Card marked as Annex “A” .

9) I am filing this petition at the LCRP of Oslob, Cebu , Province of Cebu .

Republic of the Philippines

Petitioner: JESUS L. LIBATON JR. Petition No. CCE-003-2005

MOTION FOR RECONSIDERATION

1. On February 14, 2005 , the above-named C/MCR granted my petition for

2. I received the copy of the CRG’s decision on August 8, 2005 .

I, RONALD L. GUAREN, of legal age, married, Filipino, and residing at

That I am duly commissioned by the Regional Trial Court of Cebu City to

That my commission is valid until December 31, 2006;

That sometime on January 7, 2005, I happened to notarize a document known as

IN WITNESS WHEREOF, I have hereunto affixed my signature this 8 th day of

SUBSCRIBED AND SWORN to before me this 8 th day of August 2005, in the

Doc. No. ____ RIO C. BILOCURA

A FF I DAV IT OF AUTHORIZATION AND CONSENT

I, VICTORIA E. DICDICAN, of legal age, married, Filipino, and residing in

That I am the wife of VICTORIO DICDICAN (also known as VICTORINO

That, considering that my authorization and consent is required before my

That I further sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 22nd day of

SUBSCRIBED AND SWORN to before me this 22nd day of February 2008, in

SUBSCRIBED AND SWORN TO before me this _ day of ____________ in

Doc. No. _ ________________________________

Date: __________

2. I was born on December 9, 1957 at _______ Basay .

SUBSCRIBED AND SWORN TO before me this _day of ____________,

SUBSCRIBED AND SWORN TO before me this _day of ____________,