APPLICATION FOR BIRTH CERTIFICATE

(WRITTEN IN CAPITAL LETTTERS ONLY)

To
The Registrar,
Birth & Deaths,
Municipal Coporation,
Warangal.

Ward No. (

Sir,

Sub: Issue of Birth Certificate - Requested - Reg.

***
Kindly issue me Birth Certificate of my (Daughter / Son) Relation

1.
2.
3.

Date of Birth of Child / { |{q

~} :
Sex (Male / Female) d / |sTw&T :
Place of Birth / +q d\
eTT :
(Hospital Name & Address / House Address) :
{ dT|

4.

|sT sTHe / +{ sTHe}

Name of the Child / Entered Child Name as :

(In Block Letters with Sur-name)

(Xe |sT +^wH yjTeqT)

(If Child name once entered it cannot be changed)
(Include child name in Engligh only)

{ k] qy<T #dq |sT ] es&<T }

5.

Name of the Childs Father

{ Xe

6.

7.

+& |sT}

Name of the Childs Mother

{ Xe

* |sT}

Name of the Applicant &

Complete Address
{ <sUdT

<sT |sT eT]jTT sTHe}

Date:
Note:

Signature of the Applicant

1) Birth Certificate will be issued subject to entry found registered with WMC Records as
recorded in Birth Register.

H{ : 1) qq ]w s Y qy < T & q qH\ , ]w s Y qy < q | s e TT e y T qq < e| e TT e& T qT.

2) Enclose copy of Hospital Discharge Card / Birth Certificate issued from the Hospital.

2) dT| ysT q &#]sT / qq <e|eTT |s#eqT.

DECLARATION

d H+: