Panchayat:Repo18/vol2-page0414

Total (a+b)
Total should be equal to the number of Birth Report Forms (Form No. 2) attached with this monthly report.
Signature & Name of the Registrar

Dated:

Submitted to the Chief Registrar/District Registrar.

FORM No. 12
[See Rule 14]
SUMMARY MONTHLY REPORT OF DEATHS

1. Report for the Month of....... Уеar...........
2. District:
3. Town/village:
4. Registration Unit:
5. Details of Deaths Registered during the Month:

Death
Registered within one year of occurrence Registered after on year of occurrence Total Infant Deaths Maternal deaths
1 2 3 4 5

Maternal Deaths Registered Registered Totar Infant Deaths within one after one year of year of occurrence (1) (2) (3) (4) (5) Note:- Infant Material Deaths should also be included in the Deaths.
The Number of Statistical Reporting Form (Form No. 4) attached should be equal to the number of deaths registered.

Signature & Name of the Registrar.

Dated
Submitted to the Chief Registrar/District Registrar.

FORM NO. 13

[See Rule 14]

SUMMARY MONTHLY REPORT OF STILL BIRTHS

1.Report for the Month of........... Уear..............
2. District:
3.Town/Village:
4. Registration Unit
5. Number of Still Births Registered
Number of Still Births Registered should be equal to the number of Still Birth Report Forms (Form No. 3) attached with this monthly report.
Signature & Name of the Registrar

Dated:
Submitted to the Chief Registrar/District Registrar.