RA 9048 Form No. 1.

1 (LCRO)

Republic of the Philippines

Local Civil Registry Office
Province: Cebu
Municipality of Balamban

Republic of the Philippines ) Petition No.: ________________

Municipality of Balamban ) SS

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE

CERTIFICATE OF LIVE BIRTH

I, ____________________, of legal age, Filipino, and a resident of Barangay Liki,

Municipality of Balamban, Cebu after having been sworn to in accordance with law, hereby
declare that:
1) I am the petitioner seeking the correction of entry in:
a) The certificate of live birth of ____________________, my birth certificate.
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2) I was born on March 16, 1983 in Municipality of Vallehermoso, Negros Oriental.

3) The birth was recorded under registry number 154 (C-83).

4) The clerical error(s) to be corrected is/are (use additional sheets, if necessary)

ITEM NO. DESCRIPTION FROM TO

5) The facts/reasons for filing this petition are the following:

Correction of erroneous entry to reflect the correct spelling of my first name and
sex in my birth certificate.

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

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 or Court of the Philippine Consulate.

8) I am filing this petition at the LCRO of Municipality of Balamban, Province of Cebu in

accordance with RA 9048 and its implementing rules and regulations.

Affiant

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 VERIFICATION

I, __________________________ under oath, states:

1. I am the petitioner of the above petition for correction of clerical error of entries of the
birth certificate of myself, FELIZARDA CANOY ORTEGA;
2. I have caused the preparation of this petition;
3. I have read the petition and all the facts stated here are true and correct to the best of my
personal knowledge and based on authentic records.

IN WITNESS WHEREOF, I have affixed my signature this 8 th day of July 2022 at

Municipality of Balamban, Cebu.

Affiant
SUBSCRIBED AND SWORN to before me this 8th day of July 2022 at Municipality of
Balamban, Cebu, petitioner exhibited to me her DSWD identification No. 072208018-2237-
00002 issued at Balamban, Cebu, as proof of identity.

Doc No.: ____

Page No.: ____
Book No.: ____
Series of: ______

For C/MCR use only

ACTION TAKEN BY THE C/MCR

Granted Denied (Provide basis for denial)

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Date: ________ ________________________

City/Municipal Civil Registrar

For CRG use only

ACTION TAKEN BY THE CRG

Affirmed Impugned

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Date: ____________ _______________________

City Registrar General

OR No.: _________________________
Amount Paid: _____________________
Date Paid: ________________________