Republic of the Philippines

OFFICE OF THE CITY/MUNICIPAL CIVIL REGISTRAR

Province: _________________________
City/Municipality: _____________________

Republic of the Philippines )

______________________ ) S.S Petition No. ______________________

PETITION FOR CHANGE OF FIRST NAME

I, ___________________________________________, of legal age, ______________,

(complete name of petitioner) (nationality/citizenship)
and a resident of
_________________________________________________________________, (complete
address) after having been duly sworn to in accordance with law, hereby declare that:

1) I am the petitioner seeking change of first name.

2) I was born on ____________________ (date of birth) at

_______________________, (city/municipality)
__________________________________________(province), _____________________
(country).

3) The birth was recorded under registry number _____________________.

4) The first name to be changed is from ________________ to _________________.

5) The grounds for filing of this petition are the following: [INDICATE GROUND AND
EXPLAIN/JUSTIFY]

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

b) I have habitually and continuously used ____________ and I am publicly known
in the community with that first name;
c) The first name is tainted with dishonor;
d) The first name is ridiculous;
e) The first name causes confusion;
f) Other: [SPECIFY]

6) I submit the following documents to support this petition: (Use additional sheets, if
necessary.)

a) ____________________________________________________________
b) ____________________________________________________________
c) ____________________________________________________________
d) ____________________________________________________________

7) I have 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 _______________________ (City/Municipality) ,

_______________________ (Province) in accordance with R.A. No. 9048, as amended by
R.A. No. 10172 and its implementing rules and regulations.
 ___________________________________
Signature over printed name of petitioner

VERIFICATION

I, ___________________________________, the petitioner, hereby certify that the

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

___________________________________
Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this __________ day of ______________________

in the city/municipality of ____________________, petitioner exhibiting his (Government
Issued ID) No. ________________ issued at ______________________________ on
_______________________ .

___________________________
Administering Officer

Doc. No. ________________

Page No. ________________
Book No. ________________
Series of _________________