Panchayat:Repo18/vol2-page0411

മാതാവിന്റെ പേര്/Name of Mother .......................................  . . . . . . . . . . . . . . . . . . . . . . . . . .പിതാവിൻറെ /ഭർത്താവിൻറെ പേര്/ Name of Father/Husband................................... മരിച്ച വ്യക്തിയുടെ മരണസമയത്തെ                                                                                                                                                                         മരിച്ച വ്യക്തിയുടെ സ്ഥിരമായ മേൽവിലാസം                                                                                                                                                                                                         മേൽവിലാസം                     Address of the deceased at the time of death                                                                                                                                                 Permenant address of deceased .............................................................                                                                                                                                                      .......................................................... രജിസ്ട്രേഷൻ നം/Registration No...........                                                                                                                       രജിസ്ട്രേഷൻ തീയതി/Date of Registration................... Remarks (if any) .............................                                                                                                                                                                                                                നൽകുന്ന തീയതി/ Date if Issue..........................................

നൽകുന്ന അധികാരിയുടെ ഒപ്പ്/ Signature of the issuing authority.................................
നൽകുന്ന അധികാരിയുടെ മേൽവിലാസം / Address of the issuing authority................................
സീൽ/SEAL
"Ensure registration of every birth and death"
ഓരോ ജനനവും മരണവും രജിസ്റ്റർ ചെയ്തുവെന്ന് ഉറപ്പുവരുത്തുക
FORM No. 7
[See Rule 12]
BIRTH REGISTER
BIRTH REPORT
Legal information
Form No. 1
This part to be added to the Birth Register

To be filled by the informant

1. Date of Birth: (Enter the exact day, month and year the child was born e.g. 1.1.2000)
2.Sex: (Enter "Male or 'Female, do not use abbreviation)
3. Name of the child, if any: (if not named, leave blank)
4. Name of the father: (Full name as usually written)
5. Name of the mother: (Full name as usually written)
5A. Permanent address of the parents
5B. Address of the parents at the time of birth of the child
6. Place of birth: (Tick the appropriate entry 1 or 2 below and give the name of the Hospital/Institution or the address
of the house where the birth took-place)
1. Hospital/         Name:
Institution
2. House                 Address:
7. Informant's name:
Address:
(After completing all columns 1 to 20, informant will put date and signature here.)
Date:                                                                                                                                           Signature of left thumb marks of the informant


To be filled by the Registrar