RA 9048 Form No. 1.

2 (Philippine Consulate General, NY)
(Revised 30 Sept. 2010)
Republic of the Philippines
Philippine Consulate General
LOS ANGELES,
New CALIFORNIA
York, New York

_______________________________)
_______________________________) SS Petition No. ______________________

PETITION FOR CORRECTION OF CLERICAL ERROR
IN THE CERTIFICATE OF LIVE BIRTH

I, _______________________________________________________, of legal age, _________,
and a resident of _____________________________________________________________________,
(complete address)
after having duly 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 __________________ at ______________________________________,
(city/ municipality)
______________________________________________, _____________________________________.
(province) (country)
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 necessary)
For error No. 1: ___________________________________________________________
___________________________________________________________
___________________________________________________________
For error No. 2: ___________________________________________________________
___________________________________________________________
___________________________________________________________
For error No. 3: ___________________________________________________________
___________________________________________________________
___________________________________________________________

6) I submit the following documents to support this petition: (Use additional sheets, if necessary)
a. ________________________________________________________________
b. ________________________________________________________________
c. ________________________________________________________________
d. ________________________________________________________________
e. ________________________________________________________________

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 Philippine Office of Consulate the Consul General General of Angeles. ________________________ Series of ________________________ ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO. hereby certify that the allegations herein are true and correct to the best of my knowledge and belief. petitioner exhibiting his Passport No. _____________________________________________ Administering Officer Doc. 1 (Provide the basis for the action taken. _____________________________________________ Signature over printed name of petitioner SUBSCRIBED AND SWORN to before me this. USA in accordance with R. York.) [ ] Granted [ ] Denied ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO. No. ________________________ Page No. No. 2 (Provide the basis for the action taken.) [ ] Granted [ ] Denied ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ .A. the petitioner. in Los Philippine Consulate California USA General in of New accordance with RA 9048 as amended and its Implementing Rules and Regulations. ______________________________________________________. _____________________________________________ Signature over printed name of petitioner VERIFICATION I. _______________ issued at _____________________________ on ________________________. ________________________ Book No. 9048 and its implementing rules and regulations. _______ day of ______________________ in the city/ municipality of ____________________________________. New York.

3 (Provide the basis for the action taken. 3 (Provide the basis for the action taken. 2 (Provide the basis for the action taken.) O. ___________________________ Amount paid ___________________________ Date paid ___________________________ .R.) [ ] Affirmed [ ] Impugned ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ For CRG use only: ACTION TAKEN BY CRG ON ERROR NO. No.) [ ] Affirmed [ ] Impugned ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ For CRG use only: ACTION TAKEN BY CRG ON ERROR NO. 1 (Provide the basis for the action taken. ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO.) [ ] Granted [ ] Denied ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________________________________ Consul General Date: _________________________ For CRG use only: ACTION TAKEN BY CRG ON ERROR NO.) [ ] Affirmed [ ] Impugned ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Date: ___________________________ ______________________________________ Civil Registrar General Payment of filing fee (Please attach copy of the official receipt.

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