RA 9048 Form No. 1.

2 (Philippine Consulate General, NY)

(Revised 30 Sept. 2010)
Republic of the Philippines
Philippine Consulate- Consular
Embassy of the Philippines General Section
LOS ANGELES,
New CALIFORNIA
York, New York
Washington, D.C.

_______________________________)
_______________________________) 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) Officeofof Consulate
I am filing this petition at the Philippine
Office the Consul
the Consul General
in in
General
General Washington,
of
Los Philippine
Angeles, D.C.,
Consulate
California USA General
in of New
accordance with RA 9048 as amended and its Implementing Rules and Regulations.
York, New York, USA in accordance with R.A. No. 9048 and its implementing rules and
regulations.

_____________________________________________
Signature over printed name of petitioner

VERIFICATION
I, ______________________________________________________, 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 his Passport
No. _______________ issued at _____________________________ on ________________________.

_____________________________________________
Administering Officer

Doc. No. ________________________

Page No. ________________________
Book No. ________________________
Series of ________________________

ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO. 1

(Provide the basis for the action taken.)
[ ] Granted [ ] Denied
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO. 2

(Provide the basis for the action taken.)
[ ] Granted [ ] Denied
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
 ACTION TAKEN BY THE CONSUL GENERAL ON ERROR NO. 3
(Provide the basis for the action taken.)
[ ] Granted [ ] Denied
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

___________________________________
Consul General

Date: _________________________

For CRG use only:

ACTION TAKEN BY CRG ON ERROR NO. 1
(Provide the basis for the action taken.)
[ ] Affirmed [ ] Impugned
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

For CRG use only:

ACTION TAKEN BY CRG ON ERROR NO. 2
(Provide the basis for the action taken.)
[ ] Affirmed [ ] Impugned
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

For CRG use only:

ACTION TAKEN BY CRG ON ERROR NO. 3
(Provide the basis for the action taken.)
[ ] Affirmed [ ] Impugned
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Date: ___________________________ ______________________________________

Civil Registrar General

Payment of filing fee (Please attach copy of the official receipt.)

O.R. No. ___________________________
Amount paid ___________________________
Date paid ___________________________