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 .............................................................                                                                                                                                                      .......................................................... /Registration No...........                                         Date of Registration................... Remarks (if any) ............................. നൽകുന്ന തീയതി/ Date if Issue. നൽകുന്ന അധികാരിയുടെ as Signature of the issuing authority op(03doom (3roculaeocolo)6s (2008oslalomoo / Address of the issuing authority amylo3/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) Sex: (Enter "Male or 'Female, do not use abbreviation) 2. 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 Inserted by Kerala Gazette Extraordinary No. 440 dt. 7-3-2007.

ഈ താൾ 2018 -ലെ പഞ്ചായത്ത് റെപ്പോ നിർമ്മാണം യജ്ഞത്തിന്റെ ഭാഗമായി സൃഷ്ടിച്ചതാണ്.