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  • Application For Birth Certificate

    Transféré par

    rahidarzoo
    33 vues2 pages
    This document is an application form for a birth certificate from the Department of Health and Family Welfare. The form collects personal details of the applicant and newborn such as names, dates of birth, gender, addresses, parents' information. It also requests information about the birth such as location, weight, duration of pregnancy, and medical attention received. Applicants must provide supporting documents such as a birth certificate from a private hospital or Goanburah certificate.

    Description originale:

    IMPORTANT DOCUMENT FOR EVERY ASPECTS OF LIFE

    Titre original

    Application for Birth Certificate

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    This document is an application form for a birth certificate from the Department of Health and Family Welfare. The form collects personal details of the applicant and newborn such as names, dates of birth, gender, addresses, parents' information. It also requests information about the birth such as location, weight, duration of pregnancy, and medical attention received. Applicants must provide supporting documents such as a birth certificate from a private hospital or Goanburah certificate.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    33 vues2 pages

    Application For Birth Certificate

    Transféré par

    rahidarzoo
    This document is an application form for a birth certificate from the Department of Health and Family Welfare. The form collects personal details of the applicant and newborn such as names, dates of birth, gender, addresses, parents' information. It also requests information about the birth such as location, weight, duration of pregnancy, and medical attention received. Applicants must provide supporting documents such as a birth certificate from a private hospital or Goanburah certificate.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 2

    Department: Health and Family Welfare

    APPLICATION FOR BIRTH CERTIFICATE


    (*Marked Fields are mandatory)
    (*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

    Applicant’s Details (আবেদনকাৰীৰ বেৱৰণ)

    *Applicant’s Name (আব দনকোৰীৰ নোম) ………………………………………..


    *Applicant’s Gender ( ) Male Female
    *Mobile Number (ম োইল নম্বৰ ) ………………………………………..
    Mail Id ( ) ………………………………………..
    Pan Number ( ) ………………………………………..
    Aadhar card Number ( ) ………………………………………..

    Address Details ( )

    *State (ৰোজ্য) ………………………………………..


    *District(চজ্লো) ………………………………………..
    *Sub-Division (মহকুমো) ………………………………………..
    *Circle Office(ৰোজ্হ িক্র) ………………………………………..

    New Born's Details ( )

    Date of Birth * ( ) ………………………………………..


    Sex/Gender * ( ) Male Female
    Name of Father ( ) ………………………………………..
    Name of Mother* ( ) ………………………………………..
    Place of Birth ( ) Hospital House
    If House Address ( ঘ হয়) ………………………………………..
    Informant’s Name ( ) ………………………………………..
    Address of Parents at time of Birth
    ( স য় - ) ………………………………………..
    Birth weight (in kgs) ( ও ) ………………………………………..

    Signature of the applicant


    (আব দনকোৰীৰ িোক্ষৰ)
    Page 1 of 2
    APPLICATION FOR BIRTH CERTIFICATE
    (*Marked Fields are mandatory)
    (*চিহ্নযু ক্ত তথ্যব োৰ োধ্যতোমূ লক)

    New Born's Parents Details ( - )


    Mother Location ( চহ / ও) ………………………………………..
    Is Mother’s Town or Village ( চহ ও )Village Town

    Mother’s Name of State ( ) ………………………………………..


    Permanent Address of Parents ( - য় ) ………………………………………..
    Religion of Family ( য় ) Hindu Muslim Christian Other
    Other Religion name ( ) ………………………………………..
    Father’s Education ( ) ………………………………………..
    Mother’s Education ( ) ………………………………………..
    Father’s Occupation ( ) ………………………………………..
    Mother’s Occupation ( ) ………………………………………..
    Mother’s Age at Marriage Time ( হ স য় য়স ) ………………………………………..

    Mother’s Age at Child Birth ( স য় য়স) ………………………………………..

    Number of Children born alive including this ………………………………………..


    Type of Attention at Delivery ( স হ )
    Institutional Government Institutional Private Non-Governmental
    Doctor Nurse/Trainee Traditional Birth Attendant Relatives or Others
    Method of Delivery ( স )Natural Caesarean Foreceps/Vaccum

    Duration of Pregnancy (weeks) ( স স য়স ) ………………………………………..

    Supporting Documents (সংলগ্ন নচথ্)

    1. Certificate of birth issued from Private Hospital/Nursing home. *

    2. Goanburah certificate. *

    3. Any Other Document.

    Signature of the applicant


    (আব দনকোৰীৰ িোক্ষৰ)
    ……………~………………

    Page 2 of 2

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