RA 9048 / RA 10172 Form No. 1.
1 (C/MCRO)
(Devised 17 Aug 2003)
Republic of the Philippines
OFFICE OF THE CITY CIVIL REGISTRAR
Tagum City, Davao del Norte
Republic of the Philippines)
CITY OF TAGUM..…........) S.S
Petition No. ____________
PETITION FOR CORRECTION OF CLERICAL ERROR
IN THE CERTIFICATE OF LIVE BIRTH
I, EFREN GALLO LUCHAVEZ, of legal age, Filipino, widower, and a resident of Purok
Dela Cruz, Mankilam, Tagum City, Davao del Norte, after having been duly sworn to in
accordance with law, do hereby depose and say:-That -
1. I am the petitioner seeking for the change of first name in:
a. X my Certificate of Live Birth: EFRIN LUTCHAVEZ;
(complete name of owner)
b. ____ the Certificate of Live Birth of: ___________________;
(complete name of owner)
2. I was born on March 7, 1957, at Tagum, Davao;
2. The birth was recorded under Local Civil Registrar No. 563;
3. The clerical error to be corrected are: (Use additional sheets, if necessary);
NO
ITEM
NO. DESCRIPTION FROM: TO:
1 3 Child’s Full Name EFRIN LUTCHAVEZ EFREN LUCHAVEZ
2 4 Child’s Sex (to read as) MALE
3 6 Child’s Date of MAY 7, 1957 MARCH 7, 1957
Birth
4 7 Father’s Last Name ANATOLIO LUTCHAVEZ ANATOLIO LUCHAVEZ
5 12 Mother’s Full (to read as) SATURNINA GALLO
Name
8
6 & 13 Parent’s Nationality (to read as) FILIPINO
7 1 Place of Birth (to read as) MERCEDES, PORO, CEBU
5. The facts /reasons for filing this petition are the following: (Use additional sheets, if
necessary);
For Error No. 1. In the subject Certificate of Live Birth, my full name was
erroneously entered as EFRIN LUTCHAVEZ, instead of EFREN LUCHAVEZ,
my true and correct full name; said discrepancy was due to typographical error during
the application/registration of my birth, henceforth, I am filing this petition in order
to correct my full name from EFRIN LUTCHAVEZ to EFREN LUCHAVEZ in
my Certificate of Live Birth.
For correction No. 2. To justify that the said blurred entry, the same shall be read as
MALE, which is my true and correct sex/gender.
For Error No. 3. In the subject Certificate of Live Birth, my date of birth was
erroneously entered as MAY 7, 1957, instead of MARCH 7, 1957, my true and
correct date of birth; said discrepancy was due to typographical error during the
application of my birth, henceforth, I am filing this petition in order to correct my
date of birth from MAY 7, 1957 to MARCH 7, 1957, in my Certificate of Live
Birth.
For Error No. 4. In the subject Certificate of Live Birth, my father’s last name was
erroneously entered as ANATOLIO LUTCHAVEZ, instead of ANATOLIO
LUCHAVEZ, the true and correct last name of my father; said discrepancy was due
to clerical error during the application/registration of my birth, thus, I am filing this
petition in order to correct the last name of my father from ANATOLIO
LUTCHAVEZ to ANATOLIO LUCHAVEZ in my Certificate of Live Birth.
For correction No. 5. To justify that the said blurred entry, the same shall be read as
SATURNINA GALLO, which is the true and correct full name of my mother.
For correction No. 6. To clarify/justify that the said blurred entry, the same shall be
read as FILIPINO, the true and correct nationality of my mother.
For correction No. 7. To clarify/justify that the said blurred entry, the same shall be
read as MERCEDES, PORO, CEBU, which is my true and correct place of birth.
6. I submit the following documents to support this petition: (Used additional sheets, if
necessary:
a. PSA copy of my Certificate of Live Birth;
b. PSA copy of my Marriage Contract;
c. LCRO Certification of the Birth of my daughter-NOEME LUCHAVEZ;
d. Certificate of Death of my father-ANATOLIO LUCHAVEZ;
e. My NBI Clearance;
f. My COMELEC voter’s ID;
g. My UMID card;
h. My Senior Citizen;
7. I have not filed any similar petition and that to the best of my knowledge, no other
similar petition is pending with any C/MCRO, Court of Philippine Consulate;
8. I am filing this petition at the LCRO of Tagum City in accordance of R.A. No. 9048 /
R.A. No. 10172 and its implementing rules and regulations.
EFREN GALLO LUCHAVEZ
(Signature over printed name of petitioner)
VERIFICATION
I, EFREN GALLO LUCHAVEZ, the petitioner, hereby certify that the allegations herein
are true and correct to the best of my knowledge and belief.
EFREN GALLO LUCHAVEZ
(Signature over printed name of petitioner)
SUBSCRIBED AND SWORN to before me this _________________, in Tagum City,
Davao del Norte, Affiant having exhibited to me his Senior Citizen ID No. 135527, as proof
of identity.
Doc No. _____;
Page No. _____;
Book No. _____;
Series of ______.
RA 9048 Form No. 1.1 (LCRO)
(Devised 10 October 2001)
Republic of the Philippines
OFFICE OF THE CITY CIVIL REGISTRAR
Province: Davao del Norte
City: Tagum
Republic of the Philippines)
CITY OF TAGUM . . . . . .) S.S. Petition No. ___________________
PETITION FOR CORRECTION OF CLERICAL ERROR
IN THE CERTIFICATE OF LIVE BIRTH
I, FRANCISCO PAGAYANAN ECLE, of legal age, FILIPINO, and
(complete name of petitioner) (nationality/citizenship)
a resident of Purok 13, Hudson, Tibungco, Davao City;
(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 ROY ECLE CHUY TAN
(complete name of owner)
2) I/He/She was born on _November 05, 1974__ at _Bonifacio St., Tagum, Davao;
3) The birth was recorded under Registry Number ________;
4) The clerical error(s) to be corrected is (are):
Item No.: Description: From: To:
3 Child’s Full Name ROY ECLE CHUY TAN ROY ECLE TAN
4 Child’s Gender
(to read as) M MALE
6 Child’s Date of Birth
(to read as) Nov. 5, 1974 Nov. 5, 1974
7 Father’s Full Name
(to read as) NEO CHUY TAN NEO CHUY TAN
12 Mother’s Full Name MARIA LEONA MAKAWILI ECLE LEONA PAGAYANAN ECLE
5) The facts/reasons for filing this petition are the following: (Use additional sheets if necessary)
For error No. 1 in item 3:
That, ROY ECLE TAN is the true and correct full name of the child subject of this petition;
It is the full name that he has been using in all his official documents;
It is the full name that he is known in the community;
That, the above-mentioned discrepancy was due to typographical error as result of wrong
information/entries given by his father- Neo Chuy Tan who happened to be the birth
informant of the facts of this birth with the Office of Local Civil Registrar of Tagum City;
To avoid confusion and complication as regards to his latest official and records/documents ;
Page 2/
For error No. 5 in item 12:
The true and correct full name of the mother of the child subject of this petition as per
existing official documents is LEONA PAGAYANAN ECLE,
not MARIA LEONA MAKAWILI ECLE;
Said discrepancy was due to typographical error during the registration of birth;
Also it was due to typographical error as result of wrong information/entries given by his
father- Neo Chuy Tan who happened to be the birth informant of the facts of this birth with
the Office of Local Civil Registrar of Tagum City;
To avoid confusion and complication as regards to her latest official and records/documents ;
6) I submit the following documents to support this petition: (Use additional sheets, if necessary)
a. Certificate of Baptism of Roy Ecle Tan;
b. Certificate of Live Birth of his mother– Leona Pagayanan Ecle;
c. Certificate of Marriage of Roy Ecle Tan and Maribel E. Pura;
d. Certificate of Live Birth of his brother– Prospero Ecle Tan;
e. Certificate of Live Birth of his brother– Ronilo Ecle Tan;
f. Certificate of Live Birth of his sister– Rosalie Ecle Tan;
g. Certificate of Live Birth of his son– Jhon Kenneth Pura Tan;
h. Certificate of Live Birth of his son– Roldan Pura Tan;
i. Certificate of Live Birth of his daughter– Ashley Pura Tan;
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 Tagum City, Davao del Norte
in accordance with R.A. No. 9048 and its implementing rules and regulations.
FRANCISCO PAGAYANAN ECLE
(Signature over printed name of petitioner)
VERIFICATION
I, FRANCISCO PAGAYANAN ECLE, the petitioner, hereby certify that the
allegations herein are true and correct to the best of my knowledge and belief.
FRANCISCO PAGAYANAN ECLE
(Signature over printed name of petitioner)
SUBSCRIBED AND SWORN to before me this day ______________, in
Tagum City, Davao del Norte, affiant having exhibited to me his/her SSS I.D.
No. 09-2804394-5, as proof of identity.
Doc No. ______;
Page No. _____;
Book No. _____;
Series of 2012.
