PETITION FOR ADMINISTRATIVE ADOPTION WITH APPLICATION FOR

RECTIFICATION OF SIMULATED BIRTH RECORD

I, Merlie Dote Filipino, of legal age, married to Francisco Dote, and resident of Dacanlao Calaca City Batangas
after having been duly sworn in accordance with law, hereby depose and say:

1. That my husband has legitimate descendants, namely and aged:

a. Claire C. Dote 45
b. Aileen D. Ona 43
c. Brenan C. Dote 41

2. That before I have met my husband, I have always wanted to have a child of my own;

3. That on , I took Francisco Meriel, who was still an infant, under my care;

4. That from August 7, 2009 up to present, Fracisca Meriel (child) has been living with me and I have
considered and treated her as my own daughter;

5. That in the Certificate of Live Birth of Francisca Meriel it is stated that I are the mother as I simulated
her birth record, under the following circumstance(s):

I came across a foundling that had been entrusted to me by a friend. Driven by a deep sense of
mercy and compassion, I made the heartfelt decision to raise the child as if they were my own.
The true identity of the child’s biological parents is not known. And since I also wanted to have a
kid of my own, the circumstances led to the simulation of birth.

6. That despite the fact that I am not the biological mother of such a child, I regard her as mine, provide
her needs and love, nurture and tend her inside a home;

7. That since, me and my spouse are now legally married, we intend to legalize the existing parent-child
relationship that I have with Francisca Meriel, so that she may enjoy the benefits our existing laws
bestow upon an adopted child; I decided to come out into the open and rectify the wrong I have
Committed by filling herein Petition in accordance with Republic Act. No. 11222 otherwise known as the
“Simulated Birth Rectification Act” (regarded as the “Act” for brevity);

8. That, as may be applicable, the following persons have given the Consent to the adoption: (please
check)
, The prospective adoptee, if ten (10) years of age or over;
, The legitimate and adopted daughters and sons, ten (10) years of age or over, of the
adopter;
, The legitimate and adopted daughters and sons, (10) years age or over, of the adoptee;
, The illegitimate daughters and sons, ten (10) years of age or over, who are living with the
adopter;
, The spouse of the adopter; and,
 , The spouse of the adoptee

9. That I and my now husband, are financially, physically, and morally capable, hence in the best position
to rear and provide for the needs of Francisca Meriel.

10. That we possess all of the personal qualifications required under the Act and are qualified to adopt
Francisca Meriel

11. That following documentary requirement form part and parcel of this Petition to:

, Authenticated (simulated) Birth Certificate of the child

, Authenticated Birth Certificate of the petitioner (s)
, Affidavit of Admissionn
, Barangay Certificate
, Affidavit of two dis-interested persons
, Original CDCLAA
, Photograph (Oldest and Recent)
, Certificate of Attendance to Pre-Adoption Forum and Seminar
, Marriage Contract, Annulment Decree, Decree of Legal Seperation
, Declaration of Nullity of Marriage
, Medical Certificate of the petitioner(s)
, NBI/Police Clearance
, Bank Statement, ITR, Cert. of Employment with Pay, Others: ,
, Negative Certification of Birth
, Receipt of Socialized Fee (SWDO and/or DSWD FO)
, Consent, please specify from whom
,
,
,

That the grant of this Petition shall create a legal status to our existing parent-child relationship and shall
redound to the best interest of Francisca Meriel as she may then enjoy the benefits of a legally adopted child as
sanctioned by our laws.

PRAYER

WHEREFORE, it is respectfully prayed of the Honorable Secretary of the Department of Social Welfare
and Development, upon due notice and consideration that an Order of Adoption be issued adjudging the (minor
child) Francisca Meriel for all legal intents and purposes, my legitimate child, hereby directing that he/she shall
be known as Francisca Meriel Dote and ordering the Local Civil Registrar of , to undertake the
following:

a. Cancellation of simulated birth record of such child;

b. Issuance of the rectified birth record bearing the name of the biological parents such child/ the
issuance of a founding certificate; and,
c. Issuance of a new Birth Certificate pursuant to the Order of Adoption.
Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this , day of , hereat

,

Merlie Dote Francisco Dote

Affiant Affiant
Government Issued ID No. _______________ Government Issued ID No. _______________

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for Calaca City, Batangas this day of
___________________. Affiant personally came and appeared with their government issued IDs as herein above
stated, bearing his photograph and signature, known to me as the same person who personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said
instrument.

This instrument consists of three (3) pages including this page where the notarial seal is affixed

WITNESS WITH MY HAND AND SEAL on the date above written.

Doc No.
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Book No.
Series of 2023