RA 9048 Form - Correction of Entry (Gilig)

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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, RONEL GILIG, of legal age, FILIPINO,


(complete name of petitioner) (nationality/citizenship)
and a resident of AGUS, LAPU-LAPU CITY, CEBU, PHILIPPINES
(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) 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 JULY 2, 1991 at LAPU-LAPU CITY.
(date of birth) (city/municipality)
3) The birth was recorded under registry number 2454.
4) The clerical error(s) to be corrected is (are)

Item No. Description From To


1 NAME (MIDDLE) MIANO
6 MAIDEN NAME (MIDDLE) TAGSEP
6 MAIDEN NAME (LAST) GILIG MIANO

5) The facts/reasons for filing this petition are the following: (Use additional sheets, if
neccessary.)
For Error No.1: inadvertence; erroneously marked.
_________________________________________________________
_________________________________________________________
For Error No.2: inadvertence; erroneously marked.
_________________________________________________________
_________________________________________________________
For Error No.3: inadvertence; erroneously marked.
_________________________________________________________
_________________________________________________________
For Error No.4: _________________________________________________________
_________________________________________________________
_________________________________________________________

6) I submit the following documents to support this petition (Use additional sheets, if
necessary.)
a) PSA Certificate of Live Birth
b) PSA Certificate of Marriage of Parents of Petitioner
c) PSA Certificate of Live Birth of Parents
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 LAPU-LAPU CITY, CEBU
(city/municipality) (province)
in accordance with R.A. No. 9048 and its implementing rules and regulations.

RONEL GILIG
Signature over printed name of petitioner

VERIFICATION

I, RONEL GILIG, the petitioner, hereby certify that the allegation Herein are true and
correct to the best of my knowledge and belief.

RONEL GILIG
Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this _____ day of _____________________


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)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
____________________________________________________________________________.

Date: ________ ___________________________


City/Municipal Civil Registrar

For CRG use only

ACTION TAKEN BY THE CRG

Affirmed Impugned

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.

Date: ____________ _______________________


City Registrar General

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

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