RA 9048 Form No. 1.

1, (LCRO)
(Devised 10 October 2001)

Republic of the Philippines

Local Civil Registry Office
Province: ____________
City/Municipality: _____________
Republic of the Philippines )
_______________________ )SS

Petition No.________________

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 the 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):
Item No.
Description

From

to

5) The facts/reasons for filing this petition are the following: (Use additional sheets. if necessary.)
For error No. 1:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
For error No, 2:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
For error No, 3:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
6) I submit the following documents to support this petition: (Use additional sheets, if necessary.)
a)
_____________________________________________________________________________
b)
_____________________________________________________________________________

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c)
d)
e)
7)

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

I have/He/She has 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 LCRO of ________________________________ , _______________________

(city/municipality)

(province)

in accordance with R.A. 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 ___________________
________________________________
Administering Officer

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

__________________
__________________
__________________
__________________

For C/MCR use only

ACTION TAKEN BY THE C/MCR ON ERROR NO.1

(provide the basis for the action taken.)

Granted
Denied
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________
ACTION TAKEN BY THE CIMCR ON ERROR NO.2
(Provide the basis for the action taken.)

Granted
Denied
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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ACTION TAKEN BY THE CIMCR ON ERROR NO.3

(Provide the basis for the action taken.)

Granted
Denied
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Date: ____________________
City/Municipal Civil Registrar

For CRG use only

ACTION TAKEN BY CRG ON ERROR NO.1

(Provide the basis for the action taken.)

Affirmed
Impugned
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
ACI'ION TAKEN BY CRG ON ERROR NO.2
(Provide the basis for the action taken.)

Affirmed
Impugned
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
ACI'ION TAKEN BY CRG ON ERROR NO.3
(Provide the basis for the action taken.)

Affirmed
Impugned
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Date:____________________

_______________________________

Civil Registrar General

______________________________________________________________________________________________________________

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

O.R. No.
______________
Amount paid ______________
Date paid
______________

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