Panchayat:Repo18/vol2-page0413

(Enter the exact day, month and year e.g. 1.1.2000)
2. Sex: (Enter "Male' or 'Female' do not use abbreviation)
3. Name of the father: (Full name as usually written)
4. Name of the mother:(Full name as usually written)
5. Place of birth: (Tick the appropriate entry 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:
6. Informant's name:
Address: (After completing all columns
1 to 12 informant will put date
and signature here.)
Date:                                                                                                                                                              Signature or left thumb mark of the informant


To be filled by the Registrar

Registration No.                                                                                         Registration
Date:
Registration Unit:
Town/Village:                                                                                         District:
Remarks: (if any):

Name and Signature of the Registrar
FORM No. 10
[See Rule 13]
NON-AVAILABILITY CERTIFICATE
(issued under Section 17 of the Registration of Births & Deaths Act, 1969)
This is to certify, that search has been made on the request of Shri/Smt/Kum........................son/ wife/daughter of.......................... in the registration records for the year(s)........................ relating to (Local area)................................................................................................. of (Tahsil)..................................................................................................................................................... of (District)................................................. of (State)...................................................... and found that the event relating to the birth/death of .................................. Son/ daughter of........................................ was not registered.
Date........................................                                                                   Signature of issuing authority
Seal
FORM No. 11

[See Rule 14]
SUMMARY MONTHLY REPORT OF BIRTHS

1. Report for the Month of....... year..........
2.District:
3.Town/village:
4.Registration Unit:
5. Number of Births Registered:
(a) Within one year of their Occurrence:
(b) After one year of their Occurrence: .