Republic of the Philippines)

Province of Cagayan ) S.S.

City of Tuguegarao )

AFFIDAVIT TO USE THE FATHER’S SURNAME

I, JESSICA BANATAO LOZANO, 18 years of age, Filipino, and a

resident of Barangay Gammad, Iguig, Cagayan Valley, and after having been
sworn to in accordance with law, hereby depose and state:

1. That I am the natural/biological daughter of ALBERTO

AVILLANOSA LOZANO and MARGARITA ABANA BANATAO
who was born on June 2, 199 at Gammad, Iguig, Cagayan as
evidence by the attached Certificate of Live Birth and hereto marked
as Annex “A”;

2. That I was born out of cohabitation of my parents;

3. That I hereby declare and attest that I am choosing to use the

surname of my father LOZANO as privileged pursuant to RA 9255;

4. That said choice has already been manifested by my records as

JESSICA BANATAO LOZANO;

5. That I am executing this affidavit to attest to the truth and veracity

of the foregoing statements and for all legal intents and purposes.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affix my hand this 23rd day

of February, 2018 at Tuguegarao City, Cagayan.

JESSICA BANATAO LOZANO

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of February,

2018 at Tuguegarao City, Cagayan.

ATTY. JOEL C. AGRA

Public Attorney II
PUBLIC ATTORNEY’S OFFICE
(Pursuant to R.A. 9406)
 Republic of the Philippines
REGIONAL TRIAL COURT
Second Judicial Region
Branch___
Tuguegarao City, Cagayan

IN RE: PETITION FOR CHANGE

OF REGISTERED SURNAME OF
THE PETITIONER FROM
“BANATAO” TO “LOZANO” AND
THE INSERTION OF “BANATAO”
AS HER MIDDLE NAME.

JESSICA BANATAO LOZANO, SPL. PROC. NO.___

Petitioner,

-versus-

THE LOCAL CIVIL REGISTRAR

OF IGUIG, CAGAYAN AND
ALBERTO A. LOZANO,
Respondents.
x----------------------------------------------x

P E T I T I O N

PETITIONER, through the PUBLIC ATTORNEY’S OFFICE, by the

undersigned counsel and unto this Honorable Court, most respectfully states
that:

1. Petitioner is 18 years of age, Filipino Citizen, and a resident of Brgy.

Gammad, Iguig, Cagayan, where she may be served with notices
and other court processes of the court. The respondent has been
residing in the said address for more than three (3) years prior to
the filing of this petition.

2. Petitioner is the child of MARGARITA ABANA BANATAO and

ALBERTO AVILLANOSA LOZANO. She was born out of wedlock
on June 02, 1999 at Barangay Gammad, Iguig, Cagayan and the
fact of birth was duly registered in the Office of the respondent
Local Civil Registrar. At the time of the registration of the petitioner’s
birth, she was duly acknowledged by her father ALBERTO A.
LOZANO, a copy of his Certificate of Live Birth and Affidavit of
 Acknowledgement of Paternity are hereto attached and marked as
Annex “A” and “B”;

3. As petitioner was born out of wedlock, the surname of her mother

“BANATAO” was registered as her surname;

4. Petitioner has chosen to use and had in fact been using and
entering her surname as “LOZANO” and her middle name as
“BANATAO” from the time that she started her studies, as proof
thereof, copies of the petitioner’s school records from elementary
to senior highschool, Elementary form 137-E, Highschool Transcript
of Records, Evaluation Form for Senior Highschool and Senior
Highschool Identification Card are hereto attached and marked as
Annexes “C”, “D”, “E” and “F”, respectively;

5. This petition is being filed without the least intention of concealing

her identity or to avoid any responsibility, criminal, civil or
otherwise;

6. This petition is being filed not only because there is a necessity for
the change of the petitioner’s surname from “BANATAO” as her
middle name so as to avoid confusion as to her real identity as well
as to straighten all her records but also as an exercise of petitioner’s
right as provided under “Republic Act 9255: An act allowing
Illegitimate Children to use the Surname of their Father
xxxx.”

PRAYER

WHEREFORE, premises considered, it is most respectfully prayed of

the Honorable Court that after due notice, publication and hearing, an Order
be issued directing the Local Civil Registrar of Iguig, Cagayan to CHANGE
petitioner’s registered SURNAME from “BANATAO” to “LOZANO” and the
insertion of the MIDDLE NAME as “BANATAO”.

Other reliefs and remedies just and equitable under the premises are
likewise prayed for.

February 23, 2018 – Tuguegarao Ciy, Cagayan.

 PUBLIC ATTORNEY’S OFFICE
Department of Justice
Tuguegarao City, Cagayan

By:

ATTY. JOEL C. AGRA

Public Attorney II
IBP Lifetime Member No. 012928
Roll No. 63632

EXPLANATION

(Re: Service by Registered Mail)

Pursuant to Section 11, Rule 13 of the 1997 Rules of Civil

Procedure undersigned counsel respectfully manifest that a copy of the
foregoing Petition was served on the other parties by registered mail in lieu
of personal service due to limitation of time and distance.

ATTY. JOEL C. AGRA

Copy Furnished:

THE LOCAL CIVIL REGISTRAR

Iguig, Cagayan

THE OFFICE OF THE SOLICITOR GENERAL

134 Amorsolo Street, Legaspi Village, Makati City

ALBERTO A. LOZANO
Gammad, Iguig, Cagayan
 VERIFICATION AND
ANTI-FORUM SHOPPING CERTIFICATION
I, JESSICA BANATAO LOZANO, after having been sworn to in
accordance with law hereby depose and states:
1. That I am the PETITIONER in the above-entitled case;

2. That I have caused the preparation of the foregoing Petition;

3. That the allegations contained therein are true and correct of

my own personal knowledge and belief, and based on
authentic records and/or documents;

4. That I have not commenced any other action or proceedings

involving the same issues before the Supreme Court, Court
of Appeals, Regional Trial Court and of any other judicial,
administrative or quasi-judicial bodies and/or any other
government authority;

5. That if I should learn of any cause, petition or complaint filed

or pending before the Supreme Court, Court of Appeals,
Regional Trial Court and of any other judicial, administrative
or quasi-judicial bodies and/or any other government
authority, I undertake to report such fact within five (5) days
upon knowledge thereof.

IN WITNESS WHEREOF, we have hereunto affixed our signature this

23rd day of February, 2018 in Tuguegarao City, Cagayan.

JESSICA BANATAO LOZANO

Petitioner

SUBSCRIBED AND SWORN to before me this 23rd day of February,

2018 at Tuguegarao City, Cagayan, after the affiant exhibited to me
their proofs of identification.

ATTY. JOEL C. AGRA

Public Attorney II
PUBLIC ATTORNEY’S OFFICE
(Pursuant to R.A. 9406