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RA 9048 Form No. 1.1.

(LCRO)
(Devised 10 October 2001)

Republic of the Philippines


Province of Leyte
) SS
______________
City of Ormoc

Republic of the Philippines


Local Civil Registry Office
Province :__Leyte____
City: Ormoc____
Petition No.

PETITION FOR CORRECTION OF FIRST NAME


IN THE CERTIFICATE OF LIVE BIRTH
I,
MARIO EUGENE CASIMPAN ABENIO
______FILIPINO_________________,

, of legal age

(complete name of petitioner)

(nationality/citizenship)

And a resident of

LIBERTY LAO, ORMOC CITY, LEYTE, PHILIPPINES____________


(complete address
After having been 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)

_________ ________________________________
(relation of owner to the petitioner)

2) I/He/She was born on _MAY 7, 1968________ at ORMOC CITY


(date of birth)

__________ LEYTE

(city/municipality)

___

(province)

PHILIPPINES__________________,
(country)

3) The birth was recorded under registry number ___ 6800812_____,


4) The clerical error (s) to be corrected is (are):
Item
No.
1

Description
PETITIONERS FIRST NAME

From
EUGEN

To
MARIO EUGENE

5) The facts/reasons for filing this petition are the following: (Use additional sheets, if
necessary.)
For error No. 1
That the true and real first name of the petitioner is MARIO EUGENE not
EUGEN. But what was entered in the Petitioners Certificate of Live
Birth, particularly his first name was EUGEN instead of MARIO EUGENE.
In order for his Birth Certificate, where his first name was erroneously
entered as EUGEN, to be consistent with all his other records, this
Petition is hereby filed to correct his first name in his Certificate of Live
Birth from EUGEN to MARIO EUGENE.
6) I submit the following documents to support this petition: (Use additional sheets, if
necessary.)
a) NSO Copy of Birth Certificate containing
f) PhilHealth ID
the error
b) LCRO Copy of Birth Certificate containing
g) SSS ID
error
c) Baptismal Certificate
h) Taxpayers Identification Number
d) Police Clearance
e) Drivers License
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 Ormoc City in accordance with R.A. No. 9048 and its
implementing rules and regulations.

MARIO EUGENE CASIMPAN


ABENIO
Signature over printed name of petitioner

VERIFICATION
I, MARIO EUGENE CASIMPAN ABENIO _, the petitioner, hereby certify that the
allegations herein are true and correct to the best of my knowledge.
MARIO EUGENE CASIMPAN

ABENIO

Signature over printed name of petitioner

SUBSCRIBED AND SWORN to before me this ____ day of ____________, in the


City/Municipality of __ORMOC CITY________, petitioner exhibiting his TIN 120-253-280.

____________________________
Administering Officer
Doc. No.
Page No.
Book No.
Series of

___________
___________
___________
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