RA 9048 Form No. 1.

1 (LCRO)

Republic of the Philippines

Local Civil Registry Office
City/Municipality of __________

Republic of the Philippines) Petition No.: ________________

Province of _____ ) S.S.
Municipality of _______ )

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE

CERTIFICATE OF LIVE BIRTH

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

______________________________, after having been sworn to in accordance with law, hereby
declare that:

1) I am the petitioner seeking the correction of entry in:

a) my certificate of live birth
x
x
The certificate of Live Birth of MARIANNE TORION BAISAC who is my
daughter.
x

2) She was born on ____________________ at ________________________.

3) The birth was recorded under registry number (Local Civil Registry No. 2008-1751)

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: (use additional sheets if
necessary)
I filed this petition to make the Certificate of Live Birth of my daughter consistent
with her other documents such as her school records.

6) I submit the following documents to support this petition: (use additional sheets if
necessary)
a) Father’s Certificate of Live Birth
b) Father’s High School Diploma
c) Father’s Baptismal
d) ________________________________________________
e) ________________________________________________

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.

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 8) I am filing this petition at the LCRO of Barili, Cebu in accordance with RA 9048 and its
implementing rules and regulations.

_________________________
Signature over Printed Name

VERIFICATION

I, VIOLETA H. TORION, under oath, state:

1. I am the petitioner
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

__________________________ at Barili, Cebu, Philippines.

________________________
Signature over printed name

SUBSCRIBED AND SWORN to before me this _____________________________ at

________________________, Philippines petitioner exhibited to me her
_________________________ issued by ______________________ as competent evidence of
identity.

Doc No.: ____;

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

For C/MCR use only

ACTION TAKEN BY THE C/MCR

Granted Denied (Provide basis for denial)

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Date: ________ ________________________

City 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: ________________________