RA 9048 Form 1.

1 (LCRO)
Republic of the Philippines
City Civil Registrars Office
Davao City
Republic of the Philippines)
City of Davao
) S.S.
x-------------------------------------x

Petition No. ____________________

PETITION FOR CORRECTION OF CLERICAL ERROR IN THE CERTIFICATE OF

MARRIAGE
I, MARIA VICTORIA SANTIAGO TAN, married, of legal age, Filipino and a
resident of Dr. 1, LKT Townhouse, Rivera Village, Bajada, Davao City, Philippines,
after having been duly sworn to in accordance with law, hereby declare that:
1. I am the Petitioner seeking the correction of the clerical error in my
Certificate of Marriage.
2. The marriage was recorded under Register No. 9705320.

3. The clerical error to be corrected is:

Item No.
(1)

Description
My First Name as
stated
in
the
Certificate
of
Marriage

From
MA. VICTORIA

To
MARIA
VICTORIA

4. The fact/reason for filing this petition is the following:

a. For error No. 1: To correct my first name in my Certificate of Marriage, in
order to reflect my correct given name, as per records in the registry and
other government records.
5. I submit the following documents to support this petition:
a. My Certificate of Marriage as issued by the Civil Registrar General;
b. My Certificate of Marriage as registered in the Philippine Statistics
Authority;
c. My Certificate of Live Birth;
d. My identification documents such as my drivers license issued by the
Land Transportation Office (LTO), my ID from the Social Security System
(SSS) and my Philhealth card from the Philippine Health Insurance Corp.;
e. My passport duly issued by the Department of Foreign Affairs (DFA)
Davao.
6. I have 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.
7. I am filing this petition at the LCRO of Davao City, Province of Davao del Sur,
in accordance with R.A. 9048/R.A. 10172 and its implementing rules and
regulations.
MARIA VICTORIA SANTIAGO TAN
Petitioner
VERIFICATION

I, MARIA VICTORIA SANTIAGO TAN, the Petitioner, hereby certify that the
allegations herein are true and correct to the best of my knowledge and belief.
MARIA VICTORIA SANTIAGO TAN
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this ____________ in the City of
Davao, Philippines, petitioner exhibiting to me her LTO Drivers License No. L02-92080087 in Davao City, Philippines.
Doc No. _____;
Page No. _____;
Book No. _____;
Series of 2016.
For C/MCR use only
ACTION TAKEN BY THE CCR
(Provide the basis for the action taken)
Granted

Denied
______________________
City Civil Registrar

Date _________________
For CGR only
ACTION TAKEN BY THE CRG
(Provide for the action taken)
Affirmed

Impugned
______________________
Civil Registrar General

Date _________________
Payment of filing fee (Please attach copy of the official receipt)
O.R. No. ____________
Amount paid ___________
Date paid ______________