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(Translation)

Thor.Ror.19
Part 4
Official Emblem
BIRTH CERTIFICATE

No. ……………

This certificate is given to acknowledge the birth of …..

Name: …………………………………………... Surname: ……………………………………


Sex: ………………….. Nationality: ………………………………………………………………
Date of Birth: ……………………Month: ………………………………..Year : ………………
At : …………………………….. Hrs. Corresponding to the Day:………………………. ………
Waxing Moon:………… Waning Moon:………… Lunar Month: ……………………………
The Year of : ..………………………………… At House No. : ………..Road: ………………
Lane: …………….. Alley: ……………………………………………. Village No.:
Sub-district: ……………………………………. District: ……………………………………
Province:…………………………………………………………………………………………...
Mother's Name : …………………………………………………..Age : ……………….. Years
Mother's Nationality: ……………………………………………………………………………..
Father's Name : ………………………………………………… ...Age : ……………….. Years
Father's Nationality: ……………………………………………………………………………

May this child be blessed with happiness and prosperity.

Given on Day ……….. Month ……………… Year …………

At Registration Office: ……………………………….

Signed: ……………………………….

Position of Registrar: ………………………………

Remarks: 1. This certificate is an important document and should be kept as evidence.


2. The newborn must be named within 6 months from the date of birth and
this certificate must be presented to the Birth Acknowledging Registrar.

Certified Correct Translation

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