Republic of the Philippines

LOCAL CIVIL REGISTRY OFFICE

Province of Batangas
Municipality of Sto. Tomas


Republic of the Philippines )
Sto. Tomas, Batangas ) ss

Petition No. ________________________


PETITION FOR CORRECTION OF CLERICAL ERROR IN THE
CERTIFICATE OF LIVE BIRTH
(Pursuant to Republic Act No. 9048, as amended by
Republic Act No. 10172)


I, ___________________, of legal age, Filipino, and a resident of Brgy.
_____________, Sto. Tomas, Batangas, after having been duly sworn to in
accordance with law, hereby declare:

1. I am the petitioner seeking correction of the clerical error in my
Certificate of Live Birth;

2. I was born on _____________ at _____________, Municipality of
Sto. Tomas, Province of Batangas, Philippines;

3. The birth was recorded under Local Civil Registry No. ________;

4. The clerical error to be corrected pertains to Item No. 2 of my
Certificate of Live Birth, on the portion providing for Sex,
wherein the x mark was erroneously placed on the space for
Male instead of Female, and for this reason the wrong entry
indicated in said item for sex should be corrected/changed and
the x mark be properly placed on the space provided for
Female;

5. The facts/reasons for filing this petition are:

a) I am the person having direct and personal interest in the
correction or change of the aforesaid clerical or
typographical error in the entry for Sex in my Certificate
of Live Birth, as recorded in the civil register,;

b) In the performance of such clerical work in the writing,
copying, transcribing or typing of the entry for sex in my
Certificate of Live Birth, a harmless and innocuous mistake
Petition for Correction of Clerical Error in the Certificate of Live Birth
Page 2 of 5

or error was committed that is readily visible to the eyes
and/or obvious to the understanding, and which can be
corrected or changed by reference to other existing record;

c) The correction or change of said clerical or typographical
error in my Certificate of Live Birth under the entry for
Sex from Male to Female will forever set the record
straight in the civil register and eliminate all confusion
which have arisen or may have arisen because of such
error or mistake in the recording my true and correct sex;

d) And consequently, such correction or change in the entry
of my sex from Male to Female in my Certificate of
Live Birth will now allow me and remove any hindrance
that I may experience or have experienced in applying for
and securing government-issued identification cards,
passport, licenses, permits, or the like;

6. I am submitting the following documents, all in my name, to
support this Petition, of which I am hereto attaching and making
as integral parts hereof; namely:

a) NSO certified true copy of petitioners Certificate of Live
Birth, bearing Local Civil Registry Number _______,
marked as Annex A;

b) Certification dated ________ (Civil Registry Form No. 1A)
of the facts of petitioners birth appearing in the Register of
Births on page _____ of book number ____, issued by
____________, Municipal Civil Registrar, and as verified
by _____________, Clerk III, of the Office of the Civil
Registrar, Sto. Tomas, Batangas, marked as Annex B;

c) Petitioners earliest school record or school documents,
comprising of the following:

1) Elementary Students Permanent Record (Palaglang Tala
ng Marka sa Mababang Paaralan) issued by ____________,
Punong Guro, Marcelino Fule Memorial College,
Alaminos, Laguna, marked as Annex C;

2) Secondary Students Permanent Record, certified by
___________, Principal I, San Jose National High
School, Brgy. San Jose, Sto. Tomas, Batangas, Division
of Batangas, Region IV-A CALABARZON,
Department of Education, marked as Annex C-1;

Petition for Correction of Clerical Error in the Certificate of Live Birth
Page 3 of 5

3) National Career Assessment Examination certificate
for the ___________ examination date, with SN
_________, as administered by the National Education
Testing and Research Center (NETRC), Department of
Education, signed by Nelia V. Benito, Ph.D., Director
III, NETRC, and Secretary Jesli A. Lapus, Department
of Education, marked as Annex C-2;

4) Official Transcript of Records, certified correct by
_____________, College Registrar, Dalubhasaan ng
Lungsod ng San Pablo, San Pablo City, Laguna,
marked as Annex C-3;

d) Petitioners medical record, comprising of the following;

1) Report of the Annual Physical Examination conducted
on _____________ by Dr. ___________, Pathologist, with
License No. __________, URO Industrial Clinic, Inc.,
marked as Annex D;

2) Report of the Chest PA View Examination conducted
on __________ by Dr. ___________, with License No.
___________, URO Industrial Clinic, Inc., marked as
Annex D-1;

3) Medical Clinic-Laboratory Examination Report on the
consultation held on _______ signed by Dr. __________,
DPSP, Pathologist, MediCard Philippines, Inc., marked
as Annex D-2;

4) Medical History Report for the Annual Physical
Examination held on _____________, as evaluated by
Dr. _____________, with License No. ________, marked
as Annex D-3;

e) Medical Certification dated _________ issued by Dr.
___________, Municipal Health Officer, Municipal Health
Office, Sto. Tomas, Batangas, certifying that he has
examined herein petitioner and that after such examination
he further certifies that petitioner has not undergone sex
change or sex transplant, marked as Annex E;

f) Petitioners Baptismal Certificate issued on _________ and
signed by Rev. Fr. __________, Parochial Vicar, St.
Thomas Aquinas Parish, Sto. Tomas, Batangas,
Archdiocese of Lipa, marked as Annex F;

Petition for Correction of Clerical Error in the Certificate of Live Birth
Page 4 of 5

g) Certification dated __________ issued by _____________,
Managing Director, _______________ Inc., certifying, aside
from the fact of petitioners employment with _______ Inc.,
the fact that petitioner is of good standing and has no
pending administrative, civil or criminal case as far as
the company is concerned, marked as Annex G;

h) National Bureau of Investigation Clearance issued on
_________, with reference no. ________, certifying that
petitioner, whose name, picture and thumb print appears
thereon, has No Record on File, marked as Annex H;

i) Police Clearance issued on _________ and certified by
P/Supt. ______________, PESE, Chief of Police, Sto. Tomas
Municipal Police Station, Sto. Tomas, Batangas, certifying
that petitioner, whose picture, right thumbmark and
signature appears thereon, has NO DEROGATORY
RECORDS, marked as Annex I;

j) Certification dated __________ issued by Brgy. Chairman
___________, Brgy. _________, Sto. Tomas, Batangas,
issued for purposes of securing a Police Clearance, and
certifying therein that he knows petitioner to be of good
moral character and a law abiding citizen and that as far
as he knows, petitioner has never been charged of any
crime and has never been connected to any subversive
organization that seeks to overthrow our government or
any other government, marked as Annex J;

7. I have not filed any similar petition and that, to the best of my
knowledge, no other similar petition is pending with any Local
Civil Registry Office (LCRO), Court or Philippine Consulate;

8. I am filing this petition at the Local Civil Registry Office of Sto.
Tomas, Batangas, in accordance with Republic Act No. 9048, as
amended by Republic Act No. 10172, and its implementing rules
and regulations.


_________________________
Petitioner-Affiant







Petition for Correction of Clerical Error in the Certificate of Live Birth
Page 5 of 5

VERIFICATION

I, _______________, of legal age, after having been duly sworn in,
pursuant to law, depose and state:

1. I am the petitioner in the above-captioned Petition for Correction
of Clerical Error in the Certificate of Live Birth;
2. I have caused the preparation and filing of the said Petition;
3. I have read the contents thereof and I hereby certify that the
allegations therein are true and correct of my knowledge and
belief and are based on authentic record; and
4. I further attest to the authenticity of the annexes of the aforesaid
Petition.

________________________
Petitioner-Affiant


SUBSCRIBED and SWORN to before me this ______ day of
_________2013 in __________________________, Philippines, petitioner-
affiant presenting to me the above-entitled Petition for Correction of Clerical
Error in the Certificate of Live Birth, and identified through her Community
Tax Certificate No. __________, issued on __________ at Sto. Tomas,
Batangas, and her BIR Taxpayers Identification Number I.D. (with TIN
____________), bearing her photograph and signature and issued on
_____________ at Sto. Tomas, Batangas, who signed the document in my
presence and has sworn under penalty of law to the whole truth of the
foregoing document.


___________________________
Notary Public


Doc. No. _______
Page No. _______
Book No. _______
Series of _______