RA 9048 Form No. 4.2 (Philippine Consulate General, NY)
(Revised 30 Sept. 2010)
Republic of the Philippines
Philippine Consulate General
New York, New York
_______________________________)
_______________________________) SS Petition No. ______________________
PETITION FOR CHANGE OF FIRST NAME
I, _______________________________________________________, of legal age, _________,
and a resident of _____________________________________________________________________,
(complete address)
after having duly sworn to in accordance with law, hereby declare that:
1) I am the petitioner seeking the change of first name in:
a. [ ] my Certificate of Live Birth
b. [ ] the Certificate of Live Birth of ___________________________________________
(complete name of owner)
who is my ____________________________________________.
(relation of owner to the petitioner)
2) I/He/She was born on __________________ at ______________________________________,
(city/ municipality)
______________________________________________, _____________________________________.
(province) (country)
3) The birth was recorded under registry number ________________________________________.
4) The first name to be changed is from _____________________________________________to
_____________________________________________.
5) The grounds for filing this petition are the following: (Ground selected should be explained/
justified in a separate sheet of paper to be attached to this form.)
a. [ ] The first name is extremely difficult to write or pronounce;
b. [ ] I have/He/She has habitually and continuously used ______________________
________________________ and I/he/she is publicly known in the community
with that first name;
c. [ ] The first name is tainted with dishonor;
d. [ ] The first name is ridiculous;
e. [ ] The first name causes confusion;
6) I submit the following documents to support this petition: (Use additional sheets, if necessary)
a. ________________________________________________________________
b. ________________________________________________________________
c. ________________________________________________________________
d. ________________________________________________________________
7) I have/He/She has not filed any similar petition and that, to the best of my knowledge, no other
similar petition is pending with any LCRO, Court or Philippine Consulate.
8) I am filing this petition at the Philippine Consulate General of New York, New York, USA in
accordance with R.A. No. 9048 and its implementing rules and regulations.
_____________________________________________
Signature over printed name of petitioner
LOS ANGELES, CALIFORNIA
Philippine Consulate General in Los Angeles, California
