Republic of the Philippines

LOCAL CIVIL REGISTRY OFFICE

Province of Leyte
MacArthur, Leyte

Republic of the Philippines}

Province of Leyte } S.S. Petition No. ______
MacArthur, Leyte }

PETITION FOR THE CORRECTION OF THE

CLERICAL ERROR IN THE CERTIFICATE OF
LIVE BIRTH

I, Mr. Allan Baco Lagunzad, of legal age, Filipino, and a

resident of Brgy. Capudlosan Macarthur Leyte, 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 my

Certificate of Live Birth.

2. I was born on December 25, 1987 at Barangay Capudlosan

MacArthur, Leyte.

3. The Birth was Recorded under Registry No. 88-155.

4. The Clerical errors to be corrected are:

Item No. Description From To

1 Last name Lagonzad Lagunzad
13 Father’s Last Lagonzad Lagunzad
Name
20 Informant
(Father’s Last Lagonzad Lagunzad
Name)
 Back Page of Admission of
the Certificate Paternity Lagonzad Lagunzad
of Live Birth (Father’s Last
Name)
Back Page of Affidavit for
the Certificate Delayed
Of Live Birth Registration of
Birth Item No. Lagonzad Lagunzad
1. Petitioner’s
Last Name
Back Page of Affidavit for
the Certificate Delayed
of Live Birth Registration of Lagonzad Lagunzad
Birth Father’s
Last Name

5. The Facts/reason for Filling this Petition are the following:

That I will be processing my pertinent papers for approval but

denied due to conflicting clerical error of my certificate of live
birth such as but not limited to: Passport Processing in the DFA
(Department of Foreign Affairs), Visa Processing on the
respected proper office/agency, etc.

That I want to correct other pertinent documents needed for my

employment and for other legal purposes that may be deemed
necessary.

6. I submit the following documents to support this petition:

Annex “A” ----- Petitioner’s Certificate of Live Birth

Annex “B” ----- Petitioner’s Marriage Contract
Annex “C” ----- Petitioner’s Statement of Accumulated Value
issued by the Pag-IBIG Fund
Annex “D” ----- Petitioner’s Philhealth Identification Card
Annex “E” ------ Petitioner’s Certificate of Good Moral
Character Issued by the Abuyog Community College
Annex “F” ------ Petitioner’s Father Certification Issued by the
PSA (Philippine Statistics Authority)
Annex “G”------ Petitioner’s Father Certificate of Baptism
Annex “H” ----- Petitioner’s Father Certificate of Marriage
 7. I have not Filed and similar petition and that, to the best of my
knowledge, no longer similar petition is pending with any
LCRO, Court or Philippine Consulate.

8. I am filing this petition at the LCRO of MacArthur, Leyte in

accordance with RA 9048 and its implementing rules and
regulation.

Allan B. Lagunzad
Petitioner

VERIFICATION
I, Mr. Allan B. Lagunzad, the petitioner, hereby certify
that the allegations herein are true and correct to the best of my
knowledge and belief.

Allan B. Lagunzad
Petitioner

SUBSCRIBED AND SWORN to before me this ______

day of January, 2018. Affiant exhibiting to me his evidence of identity
PhilHealth No. 13-201940057-7.

ATTY. REX L. FLORES

Roll of Attorneys No. 67390
PTR No.9757994, 7/18/17, MacArthur, Leyte
IBP No. 003583, 5/16/17, Tacloban
MCLE Compliance - Exempt
(Recently Admitted to the BAR last May 2017)

Doc. No ____________
Page No ____________
Book No ____________
Series of 2018