REPUBLIC OF THE PHILIPPINES

LOCAL CIVIL REGISTRY OFFICE

LAS PIÑAS CITY, METRO MANILA

Republic of the Philippines)

Las Piñas City )SS. Petition No. ____________

PETITION FOR CORRECTION OF CLERICAL ERROR

IN THE CERTIFICATE OF LIVE BIRTH

I, BERNALY ARCEGA REPIA, of legal age, Filipino and a resident of 118

Almeria Bldg. Maricielo Villas, Las Piñas City, after having been duly sworn in
accordance with law, hereby depose and state that:

1. I am a petitioner seeking correction of the clerical error in my Certificate

of Live Birth.

2. I was born on March 23, 1984 at Oas Municipality Albay Province,

Philippines.

3. The birth was recorded under registry number 480 (c-84).

4. The clerical errors to be corrected are:

Item No. Description: From: To:

3 Middle Name ARCIGA ARCEGA

5. The reason I am filing this petition is to cause the correction in the spelling
of my middle name entered in my Certificate of Live Birth and which errors
are innocuous and merely clerical in nature.

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

Driver’s License No. D14-03-003537, issued at Land Transportation

Office, Las Piñas City, until March 23, 2022; PhilHealth ID. No. 08-
025442022-4; and copy of the birth record of Amelia Arcega.

7. I have not filed any similar petition involving the same issues with any
LCRO, Regional Trial Court or Philippine Consulate.

8. To the best my knowledge and belief no such petition is pending before

any LCRO, Regional Trial Court or Philippine Consulate.

9. I am filing this petition in the LCRO of Las Piñas City, Philippines in

accordance with Republic Act No. 9048 and its implementing rules and
regulations.

BERNALY ARCEGA REPIA

Petitioner
 VERIFICATION

I, BERNALY ARCEGA REPIA, the petitioner, hereby certify that the

allegations contained in the foregoing Petition for Correction of Clerical Error in
the Certificate of Live Birth are true and correct to the best of my knowledge and
belief.

BERNALY ARCEGA REPIA

Petitioner

SWORN AND SUBSCRIBED to before me on this ______ day of

______________ 2018 in Las Piñas City, with petitioner exhibiting to me her
Community Tax Certificate No. _______________ issued at _________________ on
_____________________.

Administering Officer

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