Panchayat:Repo18/vol2-page0402
402
THE REGISTRATION OF BIRTHS & DEATHS RULES, 1999
FORM - 1
Form No. 1
[See Rule 5] BIRTH REPORT FORM !! | ||
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Birth Report
Legal Information This part to be added to the Birth Register
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Birth Report Statistical Information This part to be detached and sent for statistical processing In case of multiple births, fill in a seperate form for each child and write 'Twin birth' or 'Triple birth' etc., as the case may be, in the remarks column in the box below left. | |
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)
birth of the child.] |
To be filled by the informant
8. Town or Village of Residence of the mother: (Place where the mother usually lives. This can be different from the place where the delivery occured. The house address is not required to be entered.) (a) Name of TownVillage: (b) Is it a town or village: (Tick the appropriate entry below) 1. Town 2. Village (C) Name of the District: (d) Name of State: Religion of the family: (Tick the appropriate entry below) 1. Hindu 2. Muslim 3. Christian 4. Any other religion (Write name of the religion) Father's level of education: (Enter the completed level of education e.g. If studied upto class VII but passed only class VI, write class VI) Mother's level of education: (Enter the complete level of education e.g. If studied upto class VII but passed only class VI, write Class VI) 12. Father's occupation: (If no occupation write 'Nil') |
To be filled by the informant 13. Mother's occupation:
(If no occupation write 'Nil') 14. Age of the mother (in completed years) at the time of marriage: (If married more than once, age at first marriage may be entered) 15. Age of the mother (in completed years) at the time of this birth: 16. Number of children born alive to the mother so far including this child: (Number of children born alive to include also those from earlier marriage(s), if any) 17. Type of attention at delivery: (Tick the appropriate entry below) 1. Institutional - Government 2. Institutional - Private or Non-Govern ment 3. Doctor, Nurse of Trained midwife 4. Traditional Birth Attendant 5. Relatives or others 18. Method of Delivery: (Tick the appropriate entry below) 1. Natural 2. Caesarean 3. Forceps/Vaccum 19. Birth Weight (in kgs.) (if available): 20. Duration of pregnancy (in weeks): (Columns to be filled are over. Now put signature at left) |
To be filled by the Registrar Registration No:
Registration Date: Registration Unit: Town/Village: District: Remarks (if any) Name and Signature of the Registrar |
To be filled by the Registrar Name: Code No. District: Tahsil: Town/Village: Registration Unit: To be detached and sent for statistical processing |
To be filled by the Registrar Registration No.
Registration Date: Date of Birth: Sex: 1. Male 2. Female Place of Birth: 1. Hospital/Institution 2. House Name and Signature of the Registrar |
ഈ താൾ 2018 -ലെ പഞ്ചായത്ത് റെപ്പോ നിർമ്മാണം യജ്ഞത്തിന്റെ ഭാഗമായി സൃഷ്ടിച്ചതാണ്. |