RA 9048 Form No. 1.

1 (LCRO)

Republic of the Philippines

Local Civil Registry Office
Province: Cebu
City of Danao

Republic of the Philippines ) Petition No.: ________________

City of Danao ) SS

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE

CERTIFICATE OF LIVE BIRTH

I, RACHEL HERMOSO, of legal age, Filipino, and a resident of Sitio Tangke,

Cahumayan, Danao City, 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 REYALEXA HERMOSO GEROGALIM, who
X
is my daughter.

2) She was born on December 19, 2010 at Cahumayan, Danao City, Cebu.

3) The birth was recorded under registry number 2011-37.

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

ITEM NO. DESCRIPTION FROM TO
1 Last name GEROGALEM GEROGALIM
13 Father’s surname GEROGALEM GEROGALIM

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

Correction of erroneous entry to reflect the correct spelling of her surname and his
father’s surname in her birth certificate.

6) I submit the following documents to support this petition: (use additional sheets if
necessary)
a) Her Certificate of Live Birth;
b) Certificate of Live Birth of her father, REMY SOTTO GEROGALIM.

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 Danao City, Province of Cebu in accordance with
RA 9048 and its implementing rules and regulations.

RACHEL HERMOSO
Affiant

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 VERIFICATION

I, RACHEL HERMOSO, 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 daughter REYALEXA HERMOSO DEROGALIM;
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 14 th day of December 2019 at

Cahumayan, Danao City, Cebu.

RACHEL HERMOSO
Affiant
SUBSCRIBED AND SWORN to before me this 14th day of December 2019 at
Cahumayan, Danao City, Cebu, petitioner exhibited to me her Voter’s identification No. 2223-
0071A-K1782RHH20000-9 issued at Danao City, 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

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 ACTION TAKEN BY THE CRG

Affirmed Impugned

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Date: ____________ _______________________

City Registrar General

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