Republic of the Philippines

REGIONAL TRIAL COURT

National Capital Judicial Region
Branch 5-FC
Mandaluyong City

IN THE MATTER OF CHANGE/CORRECTION

OF _____________________________________

ANGELIQUE GRACE CALAMBA, Special Pro. No.________

Petitioner, For: Correction of Entries

-versus-

OFFICE OF THE CITY CIVIL

REGISTRAR OF _____________,
Respondents.
x x

PETITION
COMES NOW, Petitioner by the Undersigned Counsel, and to this
Honorable Court, most respectfully states that:

THE CASE

1. The instant case is a petition for correction of entries in the

petitioner’s certificate of live birth seeking to correct the erroneous
surname and entry in the fact of marriage of the petitioner’s biological
parents, seeking to cancel a late registration with the Office of the Civil
Registrar of ____________;

STATEMENT OF JURISDICTION

2. Under Section 1, Rule 108, it is provided that any person interested

in the correction or cancellation of entries recorded in the civil register,
may file a verified petition with the Regional Trial Court of the province
where the corresponding civil registry is located;

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 THE PARTIES

3. Petitioner is of legal age, Filipino, single and a resident of

________________ while respondent is a public agency with office
address at _____________________________, where it may be served
with summons and other processes of this Honorable Court;

THE FACTS

4. Petitioner was born on ________________ at

_____________________ to parents ____________________________
and _____________________________;

5. Facts of her birth were registered with the Respondent Civil

Registrar of ___________, but through inadvertence, the name of the child
entered therein was _______________________________________,
instead of the correct one which should have been
_______________________________. Attached herewith is the Certificate
of Live Birth of the Petitioner issued by the National Statistics Office
(NSO) under Registry Number ____________ bearing multiple erroneous
entries marked as Annex “__” and forms an integral part of this petition;

6. Petitioner has been continuously using the name

_____________________________ since birth up to the present and she
never used at any given time the name
_________________________________ in all her dealings, personally in
school, and in community and she is well known by such name as
______________________ in her community or elsewhere. For this
purpose, an “Affidavit of Two Disinterested Persons” is attached hereto
and is made an integral part hereof as Annex “__”;

7. Petitioner had been unaware of the incorrect entries in her birth

records for a considerable length of time, until lately, when she secured a
copy of her Certificate of Live Birth from the National Statistics Office that
she discovered the foregoing errors or discrepancies.

PRAYER

WHEREFORE, in view of the foregoing, it is respectfully prayed

of this Honorable Court to issue an order DIRECTING the Office of the
Civil Registrar of ________ TO CORRECT the entries of the subject
Certificate of Live Birth in the following manner:

1. Name of the Petitioner from ________________________ TO

___________________________.

2. Date of birth from _____________, to __________________.

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 It is further prayed that the Honorable Court issue an Order directing
the NSO TO ISSUE in favor of the petitioner a new and correct birth
certificate bearing such correct name and birth date.

Other reliefs deemed legal, just and equitable in the premises are
likewise prayed for.

_______________, Philippines ___________________.

RESPECTFULLY SUBMITTED.

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