Birth Registration Form Applicant should fill all the required birth details below Birth Registration Form Applicant should fill all the required birth details below Registration No: Town: Registration Date: District: 1. Date of Birth: 2. Sex: 3. Name of the Child: 4. Name of Father: 5. Name of the Mother: 6. Place of Birth: 7. Informer Name and Address: 8. Mother's residing place City or Village: 15. At the time of Delivery Age of Mother: (Including the newly born): 16. Number of Children born to Mother 17. Place of Delivery : 18. Way or Process of Delivery 19. At the time of Birth Weight of Child : 20. Period of Pregnancy (in weeks): For Office Use Only Registrar name and signature Registrar name and signature For Office Use Only Taluk: City/Village: Name: Gender: Place of Birth: Registration Place: Registrar name and signature Date of Birth: Date: Applicant name and signature 1. Hospital - 2. Home : 3. Other Places : Name : Address : Registration No: Registration Place: Registration Date: 14. At the time of Marriage Age of Mother: 9. Religion : 10. Education of Father : 11. Education of Mother: 12. Occupation of Father: 13. Occupation of Mother: a) Name of City/Village : 1. Government Hospital 2. Private Hospital 3. Clinic d) Name of Town : c) Name of Taluk : b) Select place: 1. City 2. Village 4. Others
