RA 9048 Form No. 1.1.

(LCRO)

Republic of the Philippines

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

Republic of the Philippines )

City of Cebu ) S.S. Petition No. _____________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, ___ _____, of legal age, Filipino, married, and a resident of ________ ___________,

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) Xmy Certificate of Live Birth
b) the Certificate of Live Birth of ___________________ who is my
____son_____________.

2) I/He/She was born on __May 2, 2005___ at ___ __________.

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
neccessary.)
For Error No.1: typographical error __________________________________
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For Error No.2:_ typographical error____________________________________
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For Error No.3: _ typographical error___________________________________
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For Error No.4: ______________________________________________________
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6) I submit the following documents to support this petition (Use additional sheets, if
necessary.)
a) ______________________________________________________________
b) ____________________________________________________________________
c) ____________________________________________________________________
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 ___ _______, _____ _________ 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 31 st day of August, 2019 in the city of
Lapu-lapu, petitioner exhibiting to me his __________________ as competent proof of identity.

_________________________
Notary Public

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: ________________________