PONDICHERRY MUNCIPALITY

BIRTH REPORT

(Legal Information)

Date of Birth :

Sex (Please ) : Male Female

Name of the Child,if any :

Name of the Mother :

Name of the Father :

Place of Birth:

Hospital/Institution Name :

Or

House address :

Permanent Address of Parents:

Address of Parent’s at the time of Birth of the Child:

Birth Weight (in Kgs.):

Informant’s Name & Address:

Informant’s Adhar card No.:

To be filled by the Registrar

Registration no: Registration Date:

Registration Unit:

Town/Village: District:

@Remarks (in any):

Name and Signature of the Registrar