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REGISTRATTON OF CHILD NAME WTHIN ONE YEAR CICCURANCE

APPLICATION
FOR INCLUSION OI- CHII-D NAME IN THE BIRTI{ CERTIFICATE
From
Name
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oevtANatK
To
The Registrar of Birth and Deaths,
Narne of the mother tlf the child
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Address: il'nro:
t- ?-? 37/*7,
rysy9fficirde
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re p h o n e
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Aged about
Name of the father of the child
(*+aQ<D
& oflice Address) Residing at H-No
(Complete door no.)
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Declare that my wife Delivered Male 7 Fr*snale child at 9
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(Actualplace of Birihi on
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of Eirih;
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Hence, we Request to include our chitd name as
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(Write in Capital Letters)ln the Birth Register of ttie yt:ar
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