APPLICATION FOR NATIVITY/RESIDENTIAL CERTIFICATE Signature of the Applicant Date : Purpose of which Nativity/Residential Certificate is Required : Address of the Applicant : Name of Parent/ Guardian : Name of Applicant : ------------------------------------------------------------------------------------------------------------------------------------------- No : Date : Village Office : Village : Village Officer : This certificate is issued to be produced before the is a Native of /Permanent Resident of Village Certified on enquiry that Smt./Sri NATIVITY/ RESIDENTIAL CERTIFICATE D/o. S/o in Kerala State. DistrictTaluk
