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, JIFFER CATULONG RESTAURO, of legal age, Filipino, and a resident of 145

Laguna, Basak Pardo, Cebu City, Cebu, Philippines. 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 October 4, 1976 at Basak, Pardo, Cebu City, Cebu.
3) The birth was recorded under registry number Local Civil Registrar No. 149 (J-76).
4) The clerical error to be corrected is:

Item No. Description From To

3 Middle Name CATALONG CATULONG

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

6) I submit the following documents to support this petition (Use additional sheets, if
necessary.)
a) ____________________________________________________________________
b) ____________________________________________________________________
c) ____________________________________________________________________
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 _______________________, _________________
 (city/municipality) (province)
in accordance with R.A. No. 9048 and its implementing rules and regulations.

_______________________________________
Signature over printed name of petitioner

VERIFICATION

I, JIFFER C. RESTAURO, 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 _____ 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)

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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: ________________________