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siHT Ves faa uarferasrit,

faga-RII T UATUT-TT i s i

HEINT4,

1. fRIRI 1

Name of Child

2.
Date of Birth-

3. H 51

Place of Birth

Name of Mother:-

5.

Name of Father:

6. fT:
Sex

7.
Religion
8.
Nationality -

9
Address of parents at the time of birth of the child

10.

PermanentAddress of Parents

afefta4 1969 R 12/17 77 faaR - TTEU fqH, 1999 fH 8/13

SHTY551 feRaTrt

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