Republic of the Philippines

REGIONAL TRIAL COURT

____ Judicial Region
Branch ____

IN THE MATTER OF Special Proceedings No.

CORRECTION OF ENTRIES _____________________
IN THE BIRTH RECORD OF
CHRISTINA LEYNES PANOL
AS TO HER DATE OF BIRTH

CHRISTINA LEYNES PANOL,

Petitioner,

-versus-

THE LOCAL CIVIL REGISTRAR OF

SAN PABLO, LAGUNA and the
PHILIPPINES STATISTICS AUTHORITY,
,
Respondent,

x---------------------------------------------------------/

PETITION

PETITIONER, through counsel, and unto this Honorable Court, most

respectfully states that:

1. Petitioner CHRISTINA LEYNES PANOL, is a Filipino, of legal

age, and residing at Fairview, Quezon City. She may be served
with summons and other legal processes through the undersigned
counsel.

2. Respondents are the Philippine Statistics Authority, tasked to carry

out, enforce, and administer civil registration functions in the
country, with office address at PSA Complex, East Ave., Diliman,
Quezon City and the Local Civil Registrar Office of San Pablo,
Laguna, where births, deaths, and marriages are officially
recorded, with office address at ________, San Pablo, Laguna,
where they may be served respectively with court processes,
motions, and decisions.
 3. Petitioner was born in San Pablo, Laguna, Philippines on February
04, 1984 recorded under registry number _______________. A
copy of the Certificate of Live Birth is attached as Annex “B”.

4. The clerical error to be corrected is:

Item No. Description From To

3 Date of Birth February 4, February 14,
1984 1973

5. The ground for filing this petition is that the true and correct
birthdate of petitioner is February 14, 1973 and she has
habitually and continuously used the same in all her records
and documents.

6. To support this application, petitioner attach the following:

A) Certificate of Baptism indicating she was born on the 14 th day

of February 1973 (Annex “C”);
B) Certificate of Graduation from Damayan Elementary School
showing that in 1985, she had already graduated from
elementary school (Annex “D”);
C) Certificate of Graduation from Secondary Education from
Quiapo Parochial School, indicating that she graduated in
highschool in 1989 (Annex “E”); and,
D) Certificate of Marriage indicating her birthdate as February 14,
1973 and that she married in 1998 at the age of 25 (Annex “F”).

WHEREFORE, premises considered, after the due notice and

publication, and hearing, this Honorable Court adjudge and order herein
Respondent to effect the rectification of the Birth Record of CHRISTINA
LEYNES PANOL pertaining to the entries in her DATE OF BIRTH from
February 4, 1984 to February 14, 1973.

Petitioner prays for such other just and equitable relief.

Respectfully submitted, San Pablo, Laguna, September ___, 2018.

________________________
CHRISTINA LEYNES PANOL

Assisted by:

_____________________________
Counsel for the Petitioner
Roll of Attorney’s No. ________
IBP Member No. _____________
MCLE Compliance No. __________
 VERIFICATION AND CERTIFICATION OF
NON-FORUM SHOPPING

I, CHRISTINA LEYNES PANOL of legal age, after having been duly

sworn in accordance with law, depose and state that:

1. I am the petitioner in the above-stated case;

2. I caused the preparation of the foregoing petition;

3. I have read the contents thereof and the facts stated therein are true
and correct of my personal knowledge and/or on the basis of copies of
documents and records in my possession;

4. I have not commenced any other action or proceeding involving the

same issues in the Supreme Court, the Court of Appeals, or any other
tribunal or agency;

5. To the best of my knowledge and belief, no such action or proceeding

is pending in the Supreme Court, the Court of Appeals, or any other
tribunal or agency; and,

6. If I should thereafter learn that a similar action or proceeding has been

filed or is pending before the Supreme Court, the Court of Appeals, or
any other tribunal or agency, I undertake to report that fact within five
(5) days therefrom to this Honorable Court.

CHRISTINA LEYNES PANOL

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of September 2018

________________, affiant exhibited to me her
_________________________ at _________________ as proof of her
identity.