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Republic of the Philippines

[REGION]
[COURT]
[BRANCH], [CITY]

[NAME] __________________,
Petitioner,
SP PROC. No. _____
For Change of Name

x ------------------------------------ x

PETITION FOR CHANGE OF NAME

PETITIONER, by counsel, respectfully states that:

1. Petitioner is of legal age, [CIVIL STATUS], and a resident of [RESIDENCE];

2. He/She has been a bonafide resident of the [CITY/PROVINCE] since the year
[YEAR], or for at least three (3 years) prior to the date of the filing of this
petition;

3. His/her present name is [GIVEN NAME];

4. Such name is [INDICATE GROUND];

5. Petitioner requests that his present name be changed to [REQUESTED NAME].

PRAYER

WHEREFORE, it is respectfully prayed that, after due notice, publication, and hearing
in accordance with the Rules of Court, this Honorable Court adjudge that the petitioner’s
name of ____________ be changed to ____________.

[CITY] ___________; [DATE] _____________.

[SIGNATURE]
[NAME] ______________
Counsel for Petitioner/s
[ADDRESS] _______________________
IBP Lifetime No. ____________; [CITY] _____________
PTR No. _______________; [DATE], [CITY]
Roll of Attorney No. _______________________
MCLE Compliance No. ____________________

VERIFICATION & CERTIFICATION AGAINST FORUM SHOPPING

I, [NAME] _____________________, of legal age, do hereby state that: I am the


plaintiff in the pleading/document entitled [PLEADING/DOCUMENT BEING VERIFIED]
___________________ and in such capacity, caused this Complaint to be prepared; I have
read its contents and affirm that they are true and correct to the best of my own personal
knowledge; I hereby certify that there is no other case commenced or pending before any
court involving the same parties and the same issue and that, should I learn of such a case,
I shall notify the court within five (5) days from my notice.

IN WITNESS WHEREOF, I have signed this instrument on [DATE]_____________.

[SIGNATURE]
[NAME] _________________

SUBSCRIBED AND SWORN TO before me in the City of _______________ on this day


of [MONTH AND YEAR]_________________, affiant exhibiting before me his Government
Issued ID no. _______________ issued on [DATE}__________________ at [PLACE OF
ISSUANCE]_____________________.

[SIGNATURE]
[NAME]_______
Notary Public

Until [DATE]__________________
PTR No. [NUMBER] ____________
Issued at [PLACE]______________
On [DATE] ___________________

Doc. No.
Page No.
Book No.
Series of [YEAR] ___________.

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