Republic of the Philippines

) City of Cebu )SS

Petition No.

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE CERTIFICATE OF

LIVE BIRTH

I, JOLIZA SAAVEDRA, of legal age, Filipino, single, and a resident of Lawaan 3 Talisay
City Cebu, after having duly sworn to in accordance with law, hereby declare that:

1) I am the petitioner seeking correction of the clerical error in my Certificate of

Live Birth;
2) I was born on February 11, 1987 at the Southern Island Medical Center, Cebu
City, Philippines;
3) The birth was recorded under registry number 87-623;
4) The clerical error to be corrected is:

Item No. Description From To

1 Misspelled first JULIZA JOLIZA
name

5) The primary reason for filing this petition is that I am using the name JOLIZA
in all my records since a child;

6) I submit the following documents to support this petition:

a)
b)
c) ;

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, Court or Philippine Consulate;

8) I am filing this petition at the Local Civil Registrar of Cebu City in accordance
with R.A. No. 9048 and its implementing rules and regulations.

JOLIZA SAAVEDRA

VERIFICATION

I, JOLIZA SAAVEDRA, of legal age, Filipino, single, and a resident of Lawaan 3 Talisay
City Cebu, the petitioner, hereby certify that the allegations herein are true and
correct to the best of my knowledge and belief.

JOLIZA SAAVEDRA
SUBSCRIBED AND SWORN to before me this, day of
in the City of Cebu, petitioner exhibiting her government issued identification card
no.
issued at on .

Administering Officer/ Notary Public

Doc. No.
Page No.
Book No.
Series of 2015.