Petition For Clerical Error PDF

RA 9048 Form No. 1.1.
(LCRO)
(Devised 15 Aug. 2001)
REPUBLIC OF THE PHILIPPINES

LOCAL CIVIL REGISTRY OFFICE
Province of Pangasinan
CITY OF ALAMINOS
Republic of the Philippines )

Province of Pangasinan )
City of Alaminos ) Petition No. ______________
______________________) SS
PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH
I, ___________________________________________, of legal age, ____________________,

(complete name of petitioner) (nationality/citizenship)
and a resident of ____________________________________________________________________
(complete address)
after having been duly sworn to in accordance with law, hereby declare that:
1. I am a petitioner seeking correction of the clerical error in:
a) my Certificate of Live Birth
b) the Certificate of Live Birth of _________________________________________________
(complete name of owner)
who is my ___________________________________________________________________
(relation of owner to the petitioner)
2. I/He/She was born on _________________________ at ______________________________
(date of birth) (city/municipality)
_______________________________________, ____________________________________.
(province) (country)
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
5. The facts/reasons for filling this petition are the following: (Use additional sheets, if necessary.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
6. I submit the following documents to support this petition: (Use additional sheets, if necessary.)
a) ________________________________________________________________________
b) ________________________________________________________________________
c) ________________________________________________________________________
d) ________________________________________________________________________
7. I have not filed and similar petition and that, to the best of my knowledge, no longer similar
petition is pending with any LCRO, Court or Philippine Consulate.
8. I am filing this petition at the LCRO of ______________________, _______________________
(city/municipality) (province)
in accordance with RA No. 9048 and its implementing rules and regulations.
__________________________________
Signature over printed name of petitioner
VERIFICATION
I, ____________________________________, the petitioner, hereby certify that the allegations
herein are true and correct to the best of my knowledge and belief.
______________________________
Signature over printed name of petitioner
SUBSCRIBED AND SWORN to before me this ___________ day of _____________________

in the city / municipality of _____________________________, petitioner exhibiting his Community Tax
Certificate No. __________________ issued at __________________ on ______________________.
Doc. No. ________________

Page. No. ________________ __________________________
Book No. ________________ Administering Officer
Series of ________________
For C/MCR use only

ACTION TAKEN BY THE C/MCR
Granted Denied (Provide the basis for denial.)

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Date: _____________________ _____________________________

City / Municipal Civil Registrar
For CRG use only

ACTION TAKEN BY THE CRG
Affirmed Impugned
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Date: ____________________________ ___________________________

Civil Registrar General
Payment of filing fee (Please attach copy of the official receipt.)

O.R. No. ________________
Amount Paid ________________
Date paid ________________

Petition For Clerical Error PDF

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RA 9048 Form No. 1.1.

REPUBLIC OF THE PHILIPPINES

Republic of the Philippines )

PETITION FOR CORRECTION OF CLERICAL ERROR

I, _______________________, of legal age, ,

SUBSCRIBED AND SWORN to before me this _ day of ___________

Doc. No. ________________

For C/MCR use only

Granted Denied (Provide the basis for denial.)

Date: _ _________

For CRG use only

Date: __ _

Payment of filing fee (Please attach copy of the official receipt.)

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