Aboriginal Record of

Live Birth

Let it be known by all men that at __________A.M./ P.M. on

_______________________of the Hijiri Calendar, corr esponding to
_______________________of the Gregorian Calendar, o ccurred the live birth /
nativity of _______________________________________, a male/ female child, at
______________________[City], in the territory and/ or adjoining island of
______________________ in Al Moroc/ Amexum (America).

WHEREFORE the below signed witnesses do attest to and verify all claim to this live
birth/ nativity by these parent-parties:
Mother:__________________________________ and
Father: __________________________________ by their union.

____________________ ____________________
Child’s left foot print Child’s right foot print

Witness 1:______________________________________
Witness 2:______________________________________ Witness

3:______________________________________ Seal