Professional Regulation Commission

PETITION FOR CORRECTION OF ENTRIES/DATA

Maria Idhonna Gay A. Matute

I, ______________________________________________, of legal age, married/single, born on Passport size
______________________
October 10, 1993 Municipality of Manapla
at __________________________________________________, and colored picture with
a resident of _______________________________________________________________, name tag in plain
hereby petition for correction of entries/data in the records of the Board of/for white background
______________________________________
Nursing and the Commission. taken within the
last 6 months
Nurse
I am a registered ___________________________________ with Registration Number
0885461
________________________ October 26, 2016
dated ________________________.

NAME TO APPEAR IN THE DATABASE AND ON THE IDENTIFICATION CARD

PERSONAL DETAILS FROM TO
LAST NAME Abihay Matute
FIRST NAME Maria Idhonna Gay
MIDDLE NAME Ganoy Abihay
DATE OF BIRTH October 10, 1993
The correction of data in the records of the Board and the Commission particularly refers to the:

1. CORRECTION OF GIVEN NAME/MIDDLE NAME/SURNAME from _________________________________________ to

__________________________________________________, in order to conform to the true and correct spelling of
Given Name/Middle Name/Surname as registered in the City/Municipal Civil Registry of ____________________
______________________, as supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct name)
d. Photocopy of PRC ID

2. CORRECTION OF GIVEN NAME/MIDDLE NAME/SURNAME from _________________________________________ to

________________________________________, in order to conform to the Decision of the City/Municipal Civil
Registry as affirmed by the Civil Registry General correcting the Given Name/Middle Name/Surname pursuant to R.
A. No. 9048, as supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct name)
d. Photocopy of PRC ID

3. CORRECTION OF DATE OF BIRTH from _______________________________ to ____________________________,

in order to conform to the true and correct date of birth as registered in the City/Municipal Civil Registry of
_______________________________________, as supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct date of birth)
d. Photocopy of PRC ID
d
4. CORRECTION OF DATE OF BIRTH from _______________________________ to ___________________________, in
order to conform to the true and correct date of birth as registered in the City/Municipal Civil Registry of
_______________________, as supported by all the following documents WITH CORRECTION OF GIVEN NAME/
MIDDLE NAME/SURNAME from ____________________________________ to ______________________________,
in order to conform to the true and correct spelling of Given Name/Middle Name/Surname as registered in the
City/Municipality Civil Registry of _________________________________
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct date of birth and name)

d. Photocopy of PRC ID
d

PRD-23
Rev. 00
August 23, 2022
Page 1 of 3
x Maria Idhonna Gay Ganoy Abihay
5. CORRECTION OF GIVEN NAME/MIDDLE NAME/SURNAME from _______________________________________ to
___________________________,
Maria Idhonna Gay Abihay Matute in order to conform to the true and correct spelling of GIVEN NAME/MIDDLE
NAME/SURNAME as registered in the City/Municipal Civil Registry of _________________,
Bacolod City and the CHANGE OF
Abihay
SURNAME from ___________________________________ Matute
to __________________________________ by reason of
Arbel Amar Tigno Matute
Marriage to ________________________________________ on _________________
June 25, 2022 Bacolod City
in ________________________,
as supported by all the following documents:
x a. Original PSA copy of Certificate of Live Birth
x b. Original PSA copy of Certificate of Marriage (for registered married name only)
x c. Affidavit of Discrepancy (true and correct name)
x d. Photocopy of PRC ID
6. CORRECTION OF GIVEN NAME/MIDDLE NAME/SURNAME from ___________________________________________
to _________________________________, in order to conform to the Decision of the City/Municipal Civil Registry
as affirmed by the Civil Registry General correcting the Given Name/Middle Name/Surname pursuant to R. A. No.
9048 and the CHANGE OF SURNAME from _____________________________ to_______________________ ____ by
reason of Marriage to ___________________________________ on________________ in _____________, as
supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct name)
d. Photocopy of PRC ID
7. CORRECTION OF DATE OF BIRTH from ________________________________ to ____________________________,
in order to conform to the true and correct date of birth as registered in the City/Municipal Civil Registry of
_________________________________ and the CHANGE OF SURNAME from _______________________________
to _____________________________ by reason of Marriage to ______________________________________on
_______________ in__________________________________ as supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage (for registered married name only)
c. Affidavit of Discrepancy (true and correct date of birth and name)
d. Photocopy of PRC ID
1
8. REVERSION TO THE USE OF MAIDEN NAME from _____________________________________________________ to
______________________________________________________ and her Legal Status from MARRIED to SINGLE due
to Death of Spouse or Annulment of Marriage/Presumptive Death of Absent Spouse, as supported by all the
following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage with annotation on the decision of NULLITY
c. Original PSA copy of Certificate of Death (in case of death of spouse)
d. Photocopy of PRC ID
9. CHANGE OF MARRIED NAME TO ANOTHER MARRIED NAME from _______________________________________ to
______________________________________________, in view of Re-Marriage due to Death of former spouse or
Annulment of Marriage/Presumptive Death of Absent Spouse, as supported by all the following documents:
a. Original PSA copy of Certificate of Live Birth
b. Original PSA copy of Certificate of Marriage with annotation on the decision of NULLITY
c. Original PSA copy of Certificate of Death (in case of death)
d. Original PSA copy of Certificate of Marriage (Subsequent Marriage)
e. Photocopy of PRC ID

I DO HEREBY CERTIFY that the information and statements in this petition including the documents/exhibits
submitted in support thereof are all true and correct of my own knowledge; and that I am fully aware that any false
information or statement in this petition or in any of the documents/exhibits shall hold me administratively/criminally
and/or civilly liable.
FURTHER, I agree to the PRC Privacy Notice and hereby give my consent to the collection and processing of my
personal data in accordance thereto.

_________________ Maria Idhonna Gay A. Matute

___________________________________
Signature of Petitioner over Printed Name
Documentary Stamp
09481402628/[email protected]
____________________________________
Contact Number / E-mail Address

SUBSCRIBED and SWORN to before me this ______________ day of __________________ 20__________ at

_________________________________________, petitioner exhibiting to me his/her valid government-issued ID with ID
NUMBER______________ issued by the________________________ in ___________________on ___________________.

______________________________________
Administering Officer

PRD-23
Rev. 00
August 23, 2022
Page 2 of 3
 VERIFICATION
DO NOT FILL THIS PORTION

1. REGULATION DIVISION
Registered Name Name in the Master List / Resolution

Profession Exam Taken/ Date/ Rating

Date of Birth Date of Birth Verified by:

Registration No. Registration Date 2. FINANCE AND ADMINISTRATIVE DIVISION –

Cashier (Payment of Fees)

Year of Last Payment

Fee:
................................... OR No.: _____________________
................................... Date:_______________
....................... Amount: ____________________

Verified and assessed by:

________________________________
(Signature over Printed Name)
______________________________
(Signature over Printed Name)

PROCEDURES

1. Fill out the petition form and have it notarized.

2. Proceed to the Regulation Division for verification of registered name, examination results, and assessment
of fees.

3. Pay fees at any of the Cashier windows and get the Official Receipt.

4. Proceed to the Regulation Division and submit duly accomplished Petition Form together with the official
receipt and other required documents.

NOTE: Non-professional must present any valid government-issued ID and Special Power of Attorney (SPA) duly executed
individually by the petitioner. In case the authorized representative is a registered professional, he/she must present
his/her valid Professional Identification Card and authorization letter duly signed individually by the concerned
petitioner.

For verification of the status of your petition, please visit the PRC Website (www.prc.gov.ph). If amendment desired
is effected, proceed to apply online for your new or duplicate PRC ID, as the case may be.

PRD-23
Rev. 00
August 23, 2022
Page 3 of 3