RA 9048 Form No. 1.2 (Phil. Embassy)
(Devised 10 Oct. 2001)
Republic of the Philippines
Philippine Embassy
City of Rome, Italy
Embassy of the Philippines )
City of Rome, Italy
) SS
Petition No. CCE-_____-2010
PETITION FOR CORRECTION OF CLERICAL ERROR
IN THE CERTIFICATE OF LIVE BIRTH
I, ______________________________, of legal age, ________________,
(complete name of petitioner)
(nationality/citizenship)
and a resident of ____________________________________________________,
(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)
who is my ______________________________________________,
(relation of owner to the petitioner)
2)
3)
I/He/She was born on _______________ at ________________________,
(date of birth)
(city/municipality)
_______________________________, ____________________________.
(province)
(country)
The birth was recorded under registry number ________________________.
4)
The clerical error(s) to be corrected is (are):
Item No.
5)
Description
From
To
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 Embassy/Consulate.
8)
I am filing this petition at the Office of the Consul General in Rome, Italy,
in accordance with R.A. 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/her
Passport No. ___________________ issued in _____________ on ____________.
_________________________________
Administering Officer
Doc. No.
____________
Page No.
____________
Book No.
____________
Series of
____________
--------------------------------------------------------------------------------------------------------For CG use only
ACTION TAKEN BY THE CONSUL GENERAL
(Provide basis for the Action Taken)
 Granted
 Denied
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Date: ________________
___________________________
Consul General
For CRG use only
ACTION TAKEN BY THE CRG
(Provide basis for the Action Taken)
 Affirmed

Impugned
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Date: _______________
_________________________________
Civil Registrar General
--------------------------------------------------------------------------------------------------Payment of filing fee (Please attach copy of the official receipt)
O.R. _________________
Amount Paid ____________
Date Paid _______________