REPUBLIC OF THE PHILIPPINES

NATIONAL CAPITAL JUDICIAL REGION

REGIONAL TRIAL COURT
LAS PIÑAS CITY, BRANCH __

IN THE MATTER OF THE

PETITION FOR ADOPTION
WITH APPLICATION FOR
CHANGE OF NAME OF
_______________,
SP Proc. No. ______________
For: Adoption with Application
for Change of Name
_______________,
Petitioner,
x-------------------------------------------x

PETITION

Petitioner, ______________, by undersigned counsel, respectfully

states:

1. Petitioner, _____________, is Filipino, of legal age with

residence and postal address at _________. For purposes of this Petition, the
petitioner may be served with notices, orders and other processes of the
Honorable Court through the undersigned counsel at the address set forth
below.

2. The adoptee, __________, is Filipino, seventeen (17) years of

age and residing at _________.

Jurisdictional Facts

3. The adoptee was born on 17 April 2000 to _____________.

Attached herewith as Annexes "A" and "B" respectively are the certified
true copy of the adoptee's Certificate of Live Birth and a copy of her
Baptismal Certificate.

4. As of the time of her birth, the adoptee's parents were married.

The certified true copy of the Certificate of Marriage documenting the
marriage between __________ on 12 December 1999 is attached herewith as
Annex "C".1
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Please see marginal remarks:
"REMARKS: PURSUANT TO THE DECISION DATED APRIL 11, 2008 RENDERED BY JUDGE
SOCORRO B. INTING OF THE REGIONAL TRIAL COURT, NATIONAL CAPITAL JUDICIAL
REGION, BRANCH 4, MANILA, UNDER CIVIL CASE NO. 06-115931, THE MARRIAGE BETWEEN
 5. Subsequently, however, the marriage of the adoptee's parents
was declared null and void ab initio per the Decision dated 11 April 2008
and Decree of Nullity dated 19 May 2008 issued by the Regional Trial Court
(RTC) of Manila, Branch 4. Attached herewith as Annexes "D", "E" and
"F" respectively are copies of the Decision dated 11 April 2008, Certificate
of Finality dated 14 May 2008 and Decree of Nullity dated 19 May 2008.

6. After the dissolution of the marriage of the adoptee's biological

parents, her mother, ___________________, married the herein petitioner
on 25 January 2009. A copy of the marriage certificate between __________
and petitioner ______________ is attached herewith as Annex "G".

7. The sixteen (16) year age difference between the adopter and
the adoptee is not applicable in the present case since the adopter is the
spouse of the biological mother of the adoptee. In any event, the adopter is
twenty three (23) years older than the adoptee.

8. Since the time that the petitioner was wed to the adoptee's
mother, he has treated the adoptee as his own child and has given her the
same affection and support as his own biological children with the adoptee's
mother.

9. Because of the fatherly treatment accorded by the petitioner to

the adoptee, the latter has signified her consent to be adopted by the herein
petitioner and to change her last name to "__________". A copy of the
Affidavit of Consent executed by the adoptee is attached herewith as Annex
"H".

10. The adoptee's mother, now named _____, has likewise declared
her consent to the adoption of her daughter by the herein petitioner. A copy
of the Affidavit of Consent executed by __________ is attached herewith as
Annex "I".

11. The adoptee's biological father, __________, has likewise

signified the adoption of the adoptee by the petitioner. A copy of the
Affidavit of Consent executed by __________ is attached herewith as
Annex "J".

12. Being a full-time Grade 12 student, the adoptee has no property

under her name.

THE HEREIN PARTIES IS HEREBY DECLARED NULL AND VOID."

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 13. The adoptee is not disqualified by law to be adopted.

Personal Circumstances and Qualifications of the Petitioner

14. Petitioner possesses all the qualifications and none of the

disqualifications for adoption.

14.1. As of the filing of this Petition, the petitioner is forty (40)

years old and, therefore, of legal age.

14.2. He is in possession of his full civil capacity and legal

rights.

14.3. He is of good moral character and has not been convicted

of any crime involving moral turpitude as shown by the NBI
Clearance attached herewith As Annex "K".

14.4. The petitioner is in good physical, emotional and

psychological condition and is capable of caring for the adoptee as he
already done for several years. A copy of the Medical Certificate of
petitioner is attached herewith as Annex "L".

14.5. Petitioner is gainfully employed and, therefore,

financially capable to adopt and to support and care for his children in
keeping with the means of the family. He is the ____________. A
prominent business process outsourcing solutions company with
offices in the Philippines. A copy of the petitioner's Certificate of
Employment is attached herewith as Annex "M".

14.6. Petitioner is willing to post a bond should the Honorable

Court so require, conditioned on the faithful performance of his duties
as the adopter of the adoptee.

15. All told, the adoption prayed for in the instant Petition is in the
best interest of the adoptee as it is sought to improve the status of the
adoptee and to normalize her family life.

RELIEF

WHEREFORE, petitioner respectfully prays that, after due notice,

publication and hearing, the Honorable Court issue a decision:

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 1. Declaring __________the petitioner's legally adopted child and,
for all intents and purposes, the petitioner's own child;

2. Authorizing the change of the adopted daughter's name from

__________to __________;

3. Directing the local civil registrar of Cabanatuan, Nueva Ecija

to:

a. Record or annotate the decree of adoption on the

Certificate of Live Birth of the adoptee, __________, under Local
Civil Registry No. 2000- 5932;

b. Issue a Certificate of Live Birth which shall not bear any

notation that it is a new or amended birth certificate and which shall
show, among others, the number, date of registration, name of the
adoptee as "__________", sex, date of birth, place of birth and
citizenship of the adoptive parent;

c. Seal the original Certificate of Live Birth in the Civil

Registry records of Cabanatuan City, Nueva Ecija, which can be
opened only upon order of this Honorable Court.

4. Directing the National Statistics Office ("NSO") to issue the

Certificate of Live Birth of __________ in accordance with the Decision of
the Honorable Court.

Other reliefs, just and equitable under the circumstances, are likewise
prayed for.

Makati City for Las Piñas City, 4 December 2017.

ESCALANTE PIOQUINTO-ENRIQUEZ
ENRIQUEZ & QUIAMBAO
Counsel for Petitioner __________
7th Floor, The Athenaeum Building
160 L.P. Leviste Street, Salcedo Village
City of Makati
Telephone No. (632) 8159452
E-mail Address: info@epelawoffices.com

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By:

SALVADOR P. ESCALANTE
PTR No. 592539; 1-4-2017; Makati City
IBP No. 1063925; 1-12-17; Quezon City
Roll of Attorney No. 54608
MCLE Compliance No. V – 0021983; 6-7-16

JOHN STEPHEN P. QUIAMBAO

PTR No. 5913619; 1-4-2017; Makati City
IBP No. 1057111; 1-4-2017; Makati City
Roll of Attorneys No. 54220
MCLE Compliance No. V-0011454 ; 11-02-15

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REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.

VERIFICATION AND CERTIFICATION

I, __________ of legal age and with residence and postal address at

__________, after having been sworn in accordance with law, hereby depose
and state that:

1. I am the petitioner in the above-captioned Petition;

2. I caused the preparation of the foregoing Petition for the

adoption of __________.

3. I have read and understood the contents of said Petition and

certify that the allegations therein are true and correct based on my personal
knowledge and on authentic records;

4. I hereby certify that I have not commenced any other action or

proceeding involving the same issues in the Supreme Court, the Court of
Appeals, or the different Divisions thereof, or any other, tribunal or agency
and that, to the best of my knowledge, no such action or proceeding is
pending in the Supreme Court, Court of Appeals, the different Divisions
thereof, or any other tribunal, court or agency except the instant Petition; and

5. Should I learn that a similar action or proceeding has been filed

or is pending before the Supreme Court, the Court of Appeals, the different
Divisions thereof, or any other tribunal, court or agency, I shall notify the
court, tribunal or agency of such fact within five (5) days from knowledge.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of

November 2017 in Makati City, Philippines.

__________
Affiant

SUBSCRIBED AND SWORN to before me this __ of November

2017, affiant exhibiting to me her Passport No. EC7711092 issued on May
14, 2016 by the Department of Foreign Affairs – NCR South and valid until
May 13, 2021.

Doc No. ____;

Page No. ___;
Book No. ___;
Series of 2017.
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