Panchayat:Repo18/vol2-page0413
page 413 THE REGISTRATION OF BIRTH & DEATH RULES, 1999
'FORM - 11'
(Enter the exact day, month and year e.g. 1.1.2000) 2. Sex: (Enter "Male' or 'Female' do not use abbreviation) 3. Name of the father: (Full name as usually written) 4. Name of the mother: (Full name as usually written) 5. Place of birth: (Tick the appropriate entry below and give the name of the Hosptial/ Institution or the address of the house where the birth took place) 1. Hospital/ Name: Institution 2. House Address: 6. Informant's name: Address: (After completing all columns 1 to 12 informant will put date and signature here.) Date: Signature or left thumb mark of the informant To be filled by the Registrar Registration No. Registration Date: Registration Unit: Town/Village: District: Remarks: (if any): Name and Signature of the Registrar FORM No. 10 See Rule 13) NON-AVAILABILITY CERTIFICATE (issued under Section 17 of the Registration of Births & Deaths Act, 1969) This is to certify, that search has been made on the request of Shri/Smt/Kum.................. son/ wife/daughter of............. in the registration records for the year(s)........................ relating to (Local area)................................................................................................. of (Tahsil)..................................................................................................................................................... of (District)................................................. of (State)...................................................... and found that the event relating to the birth/death of .................................. Son/ daughter of........................................ was not registered. Date........................................ Signature of issuing authority Seal FORM No. 11 See Rule 14) SUMMARY MONTHLY REPORT OF BIRTHS Report for the Month of....... year.......... District: Town/village: Registration Unit: Number of Births Registered: (a) Within one year of their Occurrence: (b) After one year of their Occurrence:
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