SERIAL NO………………./1995
NOTARY
BIRTH CERTIFICATE
(Under section 12/17 of the Birth and Death Registration Act. 1969) GOVERNMENT OF ——-
Form No. 9
PUBLIC HEALTH DEPARTMENT
It is hereby certified that the following information is taken from the original record of birth which is entered in the register of village/city ———– Taluka ———, District ———-, State of ———-.
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1. Name:- ——-
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2. Sex of child:- (M/F)
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3. Birth Date:-
——— |
4. Registration No.:-
——— |
5. Birth Place:-
———- |
6. Date of Registration:-
———— |
7. Mother’s Name:-
———– |
8. Father’s Name:-
———— |
9. Address of mother/father:-
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—————
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Remarks:-
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Name of name of child should be got recorded within one year of birth registration, after expiry of time limit late fee Rs.2.00 will have to be paid.
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Date:—-
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