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Birth Certificate Application Chandigarh

This document is an application form for requesting the issuance of a birth certificate from the Registrar of Births and Deaths in Chandigarh, India. It requests information such as the date of birth, place of birth, names of the parents and child, and relationship of the applicant to the child. It provides instructions for officials in case any corrections need to be made to the registered particulars.

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873 views2 pages

Birth Certificate Application Chandigarh

This document is an application form for requesting the issuance of a birth certificate from the Registrar of Births and Deaths in Chandigarh, India. It requests information such as the date of birth, place of birth, names of the parents and child, and relationship of the applicant to the child. It provides instructions for officials in case any corrections need to be made to the registered particulars.

Uploaded by

deep
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Application for Issue of Birth Certificate
  • Office Use and Correction Details

CHANDIGARH ADMINISTRATION

REGISTRAR BIRTHS & DEATHS


e-JAN SAMPARK

Application for Issue of Birth Certificate(s) FOR OFFICE USE ONLY

Total Amount ___________

To Number of Copies _______

The Registrar, Receipt Number _________


Births and Deaths,
U.T., Chandigarh. Dated : ______/_____/____

Sir,

Kindly issue me the Birth Certificate(s) as per details given below :

1. Date of Birth (dd/mmm/yyyy): _______/_______/________

2. Sex : Male Female (Tick one)

3. Place of Birth (Complete Address) : ______________________________________

__________________________________________________

4. Father's Name: _______________________________________________________

5. Mother's Name: ______________________________________________________

6. Grand Father's Name: _________________________________________________

7. Permanent Address at the time of admission in Hospital/Nursing Home:

___________________________________________________________________

8. Relation of Applicant with Child (Father/Mother/Relative):

e -JAN SAMPARK : Information Gateway of Chandigarh Administration Page : 1 of 2


CHANDIGARH ADMINISTRATION
REGISTRAR BIRTHS & DEATHS
e-JAN SAMPARK

9. Registration Number (if applicant knows) _________________________________

10. Registration Date (if applicant knows) ____________________________________

11. Name of Child (with application on bond Paper) ____________________________

FOR OFFICE USE ONLY

Instructions to Dealing Hand in case of any correction filed by the applicant :

Corrected Particulars with the date of correction:

Child Name (if any): ____________________________________________

Name of Father: ________________________________________________

Name of Mother: _______________________________________________

Sex: _________ (DOC: ____/____/____)

Date of Birth: _____/_____/_____ (DOC: ____/____/____)

Place of Birth: ___________________________ (DOC: ____/____/____)

DOC - Date of Correction

Signature of Receiver with Date of receiving ______________ ______/______/_______

e -JAN SAMPARK : Information Gateway of Chandigarh Administration Page : 2 of 2

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