Form No.

9 (See Rule 9)
GOVERNMENT OF KERALA
Department of Panchayat

CERTIFICATE OF BIRTH
Issued by under section 7
of the Registration of Births & Deaths Act 1969

This is to certify that the following information has been taken from the original

record of birth which is in the register of …………………………………. of Tehsil

……………………….. of District …………………………… of State ………………..

…………… Name …………………………………….. Sex …………………………….

Date of Birth …………………………… Place of Birth …………………………………

Registration No. ………………………… Date of Registration ………………………..

Name of Father/ Mother ……………………………………………………………..

Permanent Address of Father/ Mother ………………………………………………..

………………………………………………………………………………………………

Nationality of father/ Mother ………………………………………………………………

Date (Seal) Signature of issuing authority