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Urban Local Bodies Uttar Pradesh: Birth Registration Form

This document is a birth registration form for Urban Local Bodies in Uttar Pradesh, India. It collects information such as the child's name, date of birth, gender, parents' names, place of birth, current and permanent addresses, mother's education and occupation, father's education and occupation, number of living children, nature of delivery, pregnancy length, and weight of the child. The applicant is asked to provide their signature and date at the bottom.

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AmitMaurya
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60 views1 page

Urban Local Bodies Uttar Pradesh: Birth Registration Form

This document is a birth registration form for Urban Local Bodies in Uttar Pradesh, India. It collects information such as the child's name, date of birth, gender, parents' names, place of birth, current and permanent addresses, mother's education and occupation, father's education and occupation, number of living children, nature of delivery, pregnancy length, and weight of the child. The applicant is asked to provide their signature and date at the bottom.

Uploaded by

AmitMaurya
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
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Urban Local Bodies Uttar Pradesh

Birth Registration Form


Date Of Birth* : ............./................../..................

Gender*

Male / Female / Others

Name Of Child : .

Fathers Name* : ..

Mothers Name* : .. District Name* : ..


ULB Name

: .

Zone Name

Ward Name

: ..

Mohalla Name* : ..

Place of Birth*

: ...

Home / Govt. Hospital / Private Hospital / Other

Birth Place Address* : .


Current Address*

: ..

Permanent Address : ..
Mother Resides

: .

Is

E-mail

Mobile Number* :

: Rural / Urban

Proof Of Birth: High school Mark sheet / Parent ID proof / Birth Hospital Certificate / Others

Additional Information
Mothers Education

: Literate / Illiterate

Mothers Occupation : House wife/Employee/Others

Fathers Education

: Literate / Illiterate

Fathers Occupation : Unemployed/Employee/Others

Mothers age at Marriage : ..

Mothers age at Delivery : .

Total No.of Living Children : . Nature of delivery : Natural / Caesarian / Forcip


Assistance Provided by

: Self / Doctor / Nurse / Trained Dai / Govt. Institute / Others

Pregnancy in weeks

: . Weight of child(Kg) : ..

Place ............................
Date ...../....../.........

Applicant Name
Signature

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