RA 9048 Form No. 1.1.

(LCRO)

Republic of the Philippines

OFFICE OF THE CITY/MUNICIPAL CIVIL REGISTRAR
Province: ___________________
City/Municipality:________________

Republic of the Philippines )

______________________ ) S.S. Petition No. _____________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, __LYNDON PAGUIA JURADO, JR.___, of legal age, ___________Filipino_______

(complete name of petitioner) (nationality/citizenship)
and a resident of __________ Brgy. Agus, lapu-Lapu City___________,
(complete address)
After having been 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) Xthe Certificate of Live Birth of _____ _____________________________ ________
(complete name of owner)
X
who is my
___________________________________________________________.
(relation of owner to the petitioner)
2) I/He/She was born on __September 7, 1981___ at ___Mabini, Bohol__________.
(date of birth) (city/municipality)
3) The birth was recorded under registry number ______________;
4) The clerical error(s) to be corrected is (are)

Item No. Description From To

1 Last Name Gurado Jurado

5) The facts/reasons for filing this petition are the following: (Use additional sheets, if
neccessary.)
For Error No.1: __Typographical error – misspelling__________________________
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For Error No.2: _________________________________________________________
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For Error No.3: _________________________________________________________
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For Error No.4: _________________________________________________________
_________________________________________________________
_________________________________________________________
6) I submit the following documents to support this petition (Use additional sheets, if
necessary.)
a) ___________________________________________________________
b) ___________________________________________________________
c) ___________________________________________________________
d) ___________________________________________________________
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 _______Mabini__________, _____Bohol_________
(city/municipality) (province)
in accordance with R.A. No. 9048 and its implementing rules and regulations.

______ LYNDON PAGUIA JURADO, JR.______

Signature over printed name of petitioner

VERIFICATION

I, LYDIO PAGUIA JURADO, JR., the petitioner, hereby certify that the allegations
Herein are true and correct to the best of my knowledge and belief.

_____ LYNDON PAGUIA JURADO, JR.______

Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this 31st day of August, 2019 in the
city/municipality of ____________________________, petitioner exhibiting to me his/her
____________________________ as competent proof of identity.

_________________________
Administering Officer

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

ACTION TAKEN BY THE CRG

Affirmed Impugned

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Date: ____________ _______________________

City Registrar General

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