RA 9048 Form No. 1.

1 (LCRO)

Republic of the Philippines

Local Civil Registry Office
Province of ____________________

Republic of the Philippines ) Petition No.: ________________

City of Mandaue ) SS

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

b) The certificate of live birth of_______________________, who is my ________.

2) He was born on __________________ at ____________________________________.

3) The birth was recorded under Registry Number ___________.

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

ITEM NO. DESCRIPTION FROM TO
2 SEX FEMALE MALE

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

Correction of erroneous entry to reflect the correct sex/ gender of his birth certificate.

6) I submit the following documents to support this petition: (use additional sheets if
necessary)
a) His/Her Certificate of Live Birth;

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 Maigo, Province of Lanao Del Norte 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 my son,
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

______________________
Affiant

SUBSCRIBED AND SWORN to before me this 14th day of August 2022 at Ronda,
Cebu, petitioner exhibited to me her National ID with No. 4618-5635-1038-9379 issued at
Consolacion, Cebu, as proof 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/Municipal Civil Registrar

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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: ________________________