|
1. |
Serial
No. of Birth Register |
Date |
|
2. |
Name
of Child |
|
|
3. |
Place
of Birth, Date and Hour |
Sex:
Male |
|
Female |
|
|
4. |
Name of
hospital/clinic and Doctor/midwife
who attended the deliver |
|
|
5. |
Name
and address of Mother and her
National Identity Card No. or
Nationality |
|
6. |
Name of
Father and his National Identity
Card No. |
|
7. |
Religion, Caste and Nationality of
the Father |
|
8. |
Place
of Residence and address of the
Father |
|
9. |
Occupation/Profession of the Father |
|
10. |
Name
and Address of the Person Making
Report |
|
11. |
Date of
Report |
|
Asstt.
Admin. Officer
Deputy
Director/Director |