REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

FIFTH JUDICIAL REGION
Branch 50
San Jacinto, Masbate

IN RE: PETITION FOR ADOPTION OF MIRNOR

__________________________________, SPL PROC. No. _______

__________________________ and
-------------------
Petitioners.
X- - - - - - - - - - - - - - - - - - - -X

PETITION

Petitioners, thru counsel, and unto this Honorable Court, most

respectfully aver the following, to wit:

1. Petitioners are husband and wife, Filipinos, both of legal age, and residents of
___________________;
2. They have no legitimate children or descendant and hereby sincerely desire to jointly adopt a
minor named _____________, _________ years of age, and a resident of _____________
appears in her birth certificate (Annex “A”) and school records (Annexes “______”);
3. ________ is a legitimate child of ____________ and _________;
4. That minor’s biological parents consented to the adoption by way of executing their respective
Affidavit of Consent (Annexes “_” & “___”).

 Both _____ and _____ died in an accident on the __ day of ___ last year;
5. __________ is not disqualified by law to be adopted;
6. Petitioners are in possession of all civil and legal rights and have not been convicted of any crime
involving moral turpitude;
7. They are emotionally and psychologically capable of caring for ____;
8. They are more than sixteen (16) years older than the prospective adoptee;
9. Petitioners are in a position to support and care for _______ in keeping with the means of the
family and has undergone pre-adoption services as required by Rep. Act. 8552, Sec. 4;
 10. Attched as annexes to this petition are the Child and Home Study Reports (Annexes” ___”,”___”)
conducted by ___________, a Social Worker from Department of Social and Development
(DSWD) and a Certificate from the DSWD declaring _________ to be legally available for
adoption;
11. Upon finality of the decree of adoption, ___________ shall be known and registered in the Civil
Registry as _________, following our surname.

WHEREOF, it is respectfully prayed, that upon due notice and hearing, judgment be entered:

1. Decreeing the adoption of _____ in favor of Petitioners _____;

2. Changing the name of ________ to ___________ and the same entered in the Civil Registry;
3. __________ be declared the child of herein Petitioners.

Other reliefs just and equitable are likewise prayed for.

(Venue, Date, Signature)

VERIFICATION AND CERTIFICATION

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF MASBATE )
MUNICIPALITY OF SAN JACINTO ) S.S

I, ____________, Filipino, of legal age residing at ___________________________,

after being sworn to be in accordance with law, deposes and says that:

1. I am the Plaintiff in the above-entitled case;

2. The facts stated in the above complaint are true and correct to the best of my knowledge
and authentic records;

3. I have not commenced any action or filed any claim involving the same issues in any
court, tribunal or quasi-judicial agency and, to the best of my knowledge, no such other
action or claim is pending in them; and

4. If I should learn that the same or similar action or claim has been filed or is pending after
its filing, I shall report that fact within five (5) days from notice to the court or where the
complaint or initiatory pleading has been filed.
(DATE and VENUE)

_____________________
AFFIANT

JURAT

SUBSCRIBED and sworn to before me, ____ day of ____, 2022 in the Municipality of
San Jacinto by _______ with (Identification details) _______ issued on ______ at ________ and
is valid until _______.

Doc. No. ____;

Page No. ____;
Book No. ___ ;
Series of 2022.