Download Application Form for Birth and Death Registration: Ulhasnagar

Øekad&&&&&&&&& vtZnkj & uko o iRrk (APPLICANT NAME & ADDRESS:) &&&&&&&&&&&&&&&&&&&&&&-- izfr/To] &&&&&&&&&&&&&&&&&&&&&& fuca/kd/REGISTRAR , tUe@e`R;q foHkkx (BC\DC DEPT.)mYgkluxj egkuxjikfydk mYgkluxj] &&&&&&&&&&&&&&&&&&&&&& fnukad %& @ @ fo"k; % tUe@eqR;q@vaR;fo/kh nk[kyk feG.ksckcr@tUe&eqR;q uksan vuqiyC/krspk nk[kyk@tUe&eqR;q nk[kyk nq#Lrh- tUe@e`R;q uksan.khps ikBhekxs fnysys loZ fu;e@ekfgrh eh uhV okpyh vlwu R;k fu;ek/khu jkgwu eh tUe@e`R;q nk[kys feG.;klkBh gk vtZ lknj djhr vkgs- vko';d o [kjh ekfgrh [kkfyy izek.ks vkgs-tUe e`R;w 1½ tUerkjh[k (Birth Date) 1½ e`R;wrkjh[k (Death Date) 2½ tUefBdk.k o iRrk (Birth Place & Address) 2½ e`R;qfBdk.k o iRrk (Death Place & Address) 3½ eqyxk@eqyxh (Male/Female) 3½ L=h@iq:"k (Male/Female) 4½ ckGkps Bsoysys uko (Child Name should be - In English with Correct Spelling) 4½ e`r O;Drhps laiw.kZ uko (Deceased Name) 5½ vkbZps laiw.kZ uko (Mother's full Name) 5½ vkbZ] oMhy] irhps uko (Mother/Father/Husband's Name) 6½ ofMykaps laiw.kZ uko (Father's full Name) 6½ vaR;fo/kh dsysY;k Le'kku Hkqehps uko o iRrk (Name & address of cemetery) 7½ tUekP;k osGhpk dk;e iRrk (Permanent Address @ birth) 7½ vaR;fo/kh dsysY;kpk fnukad (Date of Funeral) 8½ e`r O;Drhpk iRrk (Address of Deceased) 8½ vtkZps dkj.k (Reason for application) 9½ vtkZps dkj.k (Reason for application) Ìvuko';d etdqjkoj dkV ekjkoh [Please Mark [x] For Not Applicable] vtZnkjkph lgh [Applicant Signature] mYgkluxj egkuxjikfydk dk;kZy;klkBh 1½ j- u-&&&&&&&&&&&&&&&&&&&&&& 1½ j- u-&&&&&&&&&&&&&&&&&&&&&& 2½ tUerkjh[k &&&&&&&&&&&&&&&&&&&&&& 2½ e`R;qrkjh[k &&&&&&&&&&&&&&&&&&&&& 3½ tUefBdk.k &&&&&&&&&&&&&&&&&&&&& 3½ e`R;qfBdk.k &&&&&&&&&&&&&&&&&&&& 4½ eqyxk@eqyxh &&&&&&&&&&&&&&&&&&&& 4½ L=h@iq:"k &&&&&&&&&&&&&&&&&&&&& 5½ vkbZ@ofMykaps uko &&&&&&&&&&&&&&&&&& 5½ e;r O;Drhps iw.kZ uako &&&&&&&&&&&&&&& 6½ iRrk &&&&&&&&&&&&&&&&&&&&&&&& 6½ iRrk &&&&&&&&&&&&&&&&&&&&&&&& Ìojhy ekfgrh iw.kZ [kjh vlwu R;kph tckcnkjh ek>soj jkghy- lgh Necessary Enclosures vko';d tksMi=s 1] Birth Certificate ( For Birth at Hospital Or Maternity Home ) :­ tUe&nk[kyk ¼#X.kky; vFkok izlqfrx`gkr >kysY;k tUeklkBh ½ %& A] Xerox Copy Of Discharge Certificate. v½ #X.kky; lksMY;kP;k izek.ki=kph Nkaa;kfdar izr 2] Death Certificate ( For Death at Hospital / Home) :­ e`R;q&nk[kyk ¼#X.kky;kr @ fuoklLFkkuh >kysY;k e`R;qlkBh ½ %& A] (For Death at Hospital) Form No.4 (Original) & 3 Xerox. v½ ¼#X.kky;kr >kysY;k e`R;qlkBh½ vtZ dzz-4 lR;izr o 3 Nkaa;kfdar izrh B] (For Death at Home) Form No.4A (Original) & 3 Xerox. c½ ¼ fuoklLFkkuh >kysY;k e`R;qlkBh ½ vtZ dzz-4v lR;izr o 3 Nkaa;kfdar izrh C] Xerox Copy Of Receipt Issued By Sham Shan Bhomi In UMC Area. d½ mYgkluxj gn~nhrhy Le'kkuHkqeh e/kqu izkIr >kysY;k ikorhph Nkaa;kfdar izr-3] Cremation Certificate: -vR;afo/kh&nk[kyk %& A] For The Death Out Of UMC Area: - Attested Copy Of Doctor Certificate. v½ mYgkluxj gn~nhckgsj >kysY;k e`R;qlkBh %& MkWDVjkauh fnysY;k nk[kY;kph Lkk{kkafdr izr- B] Attested Copy Of Receipt Issued By Sham Shan Bhomi in UMC Area. c½ mYgkluxj gn~nhrhy Le'kkuHkqeh e/kqu izkIr >kysY;k ikorhph Lkk{kkafdr izr- C] For Accidental Deaths: I) Police Panchnama II) P.M. Report III) Copy of FIR d½ ¼vi?kkrh fu/kuklkBh½ % 1½ iksfyl iapukek 2½ iksLV ekVZe fjiksVZ 3½ ,Q-vk;-vkj- ph izr 4] NAC for Birth Record (For births in UMC area) :­ tUe uksan vuqiyC/krspk nk[kyk ¼QDr mYgkluxje/;s >kysY;k tUekalkBh½ %& A] Doctor Certificate v½ MkWDVjkauh fnysYkk nk[kyk B] Attested Copy Of Ration Card, Domicile Certificate, Any Valid Residence Proof In UMC Area issued by Govt./Semi Govt./Govt. Agency. c½ js'ku dkMZph Lkk{kkafdr izr] vf/koklkpk nk[kyk] 'kklu@'kkluekU; laLFksdMqu izkIr >kysY;k dk;e jfgoklkkcn~nypk iqjkO;kph izr- C] Affidavit on Rs.100/- Stamp Paper. d½ 100 :i;kaP;k LVWai isijoj lR;izfrKkys[k D] For Birth not Recorded within 10 Years: - Any Valid Proof For Birth In UMC Area issued by Govt./ Semi Govt./ Govt. Agencies e.g. School leaving Certificate. M½ 10o"kkZi;Zar tUekphuksan >kyh ulY;kl%& mYgkluxj gn~nhrhy tUeuksanhP;k iqjkO;kph lk{kkafdr izr- mnk- 'kkGk lksMY;kpk nk[kyk­ 5] NAC for Death Record (For Deaths in UMC area) :­ e`R;q ukasn vuqiyC/krspk nk[kyk ¼QDr mYgkluxje/khy #X.kky;kr @ fuoklLFkkuh >kysY;k e`R;qalkBh½ %& A] (For Death at Hospital) Form No. 4 (Original) & 3 Xerox. v½ ¼#X.kky;kr >kysY;k e`R;qlkBh½ vtZ dzz- 4 lR;izr o 3 Nkaa;kfdar izrh B] (For Death at Home) Form No. 4A (Original) & 3 Xerox. c½ ¼fuoklLFkkuh >kysY;k e`R;qlkBh½ vtZ dzz- 4 v lR;izr o 3 Nkaa;kfdar izrh C] Xerox Copy Of Receipt Issued By Sham Shan Bhomi In UMC Area. d½ mYgkluxj gn~nhrhy Le'kkuHkqeh e/kqu izkIr >kysY;k ikorhph Lkk{kkafdr izr D] Affidavit on Rs.100/- Stamp Paper. M½ 100 :i;kaP;k LVWai isijoj lR;izfrKkys[k 6] Birth Certificate For Correction (Except the Name of Child):-tUe nk[kY;krhy nq#LrhlkBh ¼eqykP;k ukok O;frfjDr ½& A] Affidavit on Rs.100/- Stamp Paper. v½ 100 :i;kaP;k LVWai isijoj lR;izfrKkys[k B] Ration Card (Xerox), Any Valid Proof issued by Govt./ Semi Govt./ Govt. Agencies c½ js'ku dkMZph Nk;kafdr izr] 'kklu@'kkluekU; laLFksdMqu izkIr lcG iqjkok- C] Correction letter from concerned Doctor d½ lacf/kr MkWDVjkadMwu nq#Lrh ckcrps i= D] Any Other document to satisfy the registration Authorities for the genuineness of the request / claim (If required) M½ nq#Lrh ckcr tUe&e`R;q fuca/kd ;kaph [kk=h gks.;klkBh brj lR;dkxni=s 7] Death Certificate For Correction.:-e`R;q nk[kY;krhy nq#LrhlkBh %& A] (For Death at Hospital) Form No. 4 (Original) & 3 Xerox. v½ ¼#X.kky;kr >kysY;k e`R;qlkBh½ vtZ dzz- 4 lR;izr o 3 Nkaa;kfdar izrh B] (For Death at Home) Form No. 4A (Original) & 3 Xerox. c½ ¼fuoklLFkkuh >kysY;k e`R;qlkBh½ vtZ dzz- 4 v lR;izr o 3 Nkaa;kfdar izrh C] Xerox Copy Of Receipt Issued By Sham Shan Bhomi In UMC Area. d½ mYgkluxj gn~nhrhy Le'kkuHkqeh e/kqu izkIr >kysY;k ikorhph Lkk{kkafdr izr D] Affidavit on Rs.100/- Stamp Paper. M½ 100 :i;kaP;k LVWai isijoj lR;izfrKkys[k E] Ration Card (Xerox), Any Valid Proof issued by Govt./ Semi Govt./ Govt. Agencies b½ js'ku dkMZph Nk;kafdr izr] 'kklu@'kkluekU; laLFksdMqu izkIr lcG iqjkok- oS|dh; vkjksX; vf/kdkjh mYgkluxj egkuxjikfydk