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Template B.C

This document is a birth certificate from Merida, Venezuela. It provides information about a birth such as the baby's name and date of birth, as well as information about the mother and father like their names and identification numbers. Witnesses to the birth are also listed along with their signatures. The document follows the standardized format used in Venezuela for registering vital records with sections for recording details about the newborn, parents, witnesses, and other details.

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Erika Idrovo
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© © All Rights Reserved
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556 views2 pages

Template B.C

This document is a birth certificate from Merida, Venezuela. It provides information about a birth such as the baby's name and date of birth, as well as information about the mother and father like their names and identification numbers. Witnesses to the birth are also listed along with their signatures. The document follows the standardized format used in Venezuela for registering vital records with sections for recording details about the newborn, parents, witnesses, and other details.

Uploaded by

Erika Idrovo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ACT N°127

Bolivarian Republic of Venezuela CNE DAY 13


National Electoral Council Electoral Power MONTH 06
Civil and Electoral Registry Commission Logo [Seal]
YEAR 2015
Merida state
Alberto Adriani Municipality
[Cutoff Seal]
Presidente Betancourt Parish

BIRTH REGISTRY X RECOGNITION INSERTION


A Data of the Civil Registrar
NAME(S): LAST NAME(S):
IDENTIFICATION DOCUMENT N° CIVIL REGISTRY OFFICE OR UNIT:
RESOLUTION N° DATE: GACETA N° X MUNICIPAL DATE:
ORDINARY OFICIAL
B Data of the person
NAME(S): FIRST LAST NAME: SECOND LAST NAME:
DATE OF DAY MONTH YEAR SEX: TIME OF BIRTH: AM
BIRTH PM
PLACE OF BIRTH: COUNTRY: STATE: MERIDA MUNICIPALITY: LOCATION:

C Data from the medical birth certificate


CERTIFICATE: DATE OF DAY MONTH YEAR ISSUING AUTHORITY: ILLEGIBLE
EXPEDITIO
N
NAME OF HOSPITAL:
D Son or Daughter of (Mother’s Information)
NAME(S): FIRST LAST NAME: SECOND LAST NAME:
IDENTIFICATION CEDULA PASSPORT OTHER AGE: ILLEGIBLE NATIONALITY:
DOCUMENT N°
PROFESSION or OCCUPATION: COMMUNITY or INDIGENOUS GROUP:
RESIDENCE: DECLARANT

DECLARANT
[Cutoff Seal]WITHOUT IDENTIFICATION PUBLIC DOCUMENT RECORD OF THE WITNESS
COMMUNAL STATEMENT
COUNCIL

E Son or Daughter of (Father’s Information)


NAME(S): FIRST LAST NAME: SECOND LAST NAME:
IDENTIFICATION CEDULA PASSPORT OTHER AGE: NATIONALITY:
DOCUMENT
PROFESSION or OCCUPATION: COMMUNITY or INDIGENOUS GROUP:
RESIDENCE: DECLARANT

DECLARANT WITHOUT IDENTIFICATION PUBLIC DOCUMENT RECORD OF THE WITNESS


COMMUNAL STATEMENT
COUNCIL

F Data of the Declarant (Only in case of being different from Father or Mother)
NAME(S) AND LAST NAME(S): CHARACTER WITH WHICH ACT
IDENTIFICATION CEDULA PASSPORT OTHER AGE NATIONALITY:
DOCUMENT VENEZUELAN
COMMUNITY or INDIGENOUS GROUP:
RESIDENCE:
G Witness Information
NAME(S) AND LAST NAME(S):
CEDULA N° AGE: PROFESSION or OCCUPATION:

NATIONALITY:
[Cutoff Seal] COMMUNITY or INDIGENOUS GROUP:
RESIDENCE:
NAME(S) AND LAST NAME(S):
CEDULA N° AGE: PROFESSION or OCCUPATION:

NATIONALITY: COMMUNITY or INDIGENOUS GROUP:


RESIDENCE:
H DATA OF THE A RECORD TO INSERT (FILL ONLY IN CASE OF INSERTION OF RECORD)
ACT N° N/A DATE DAY MONTH YEAR

ISSUING AUTHORITY
I Registration by Protection Measure (Fill only when there is a Protection Measure)
PROTECTION COUNCIL: EXTENT N° DATE DAY MONTH YEAR
NAME(S) AND LAST NAME(S) OF ADVISER :
J Registration by Judicial Decision (Fill only in case of Judicial Ruling)
COURT: JUDGEMENT N°
NAME(S) AND LAST NAME(S) OF JUDGE: N/A DATE DAY MONTH YEAR

K EXTEMPORANEOUS REGISTRATION
DATA FROM THE REPORT OF THE ADMINISTRATIVE PROTECION COUNCIL:

L Documents Presented
EV-25 CERTIFICATE
COPY OF MOTHER AND FATHERS CEDULAS
COPY OF WITNESSES CEDULAS
LEIDA LA PRESENTE ACTA Y CONFORMES CON EL CONTENIDO DE LAS MISMA, FIRMAN:
[Signature] [Signature] FINGERPRINT
SIGNATURE OF THE SIGNATURE OF THE [Fingerprint]
FINGERPRINT
DECLARANT [Fingerprint] DECLARANT
NAME: NAME:
LAST NAME: LAST NAME:
[Signature]
[Seal]
CIVIL REGISTRAR

[Signature] FINGERPRINT [Signature] FINGERPRINT


WITNESS SIGNATURE [Fingerprint] WITNESS SIGNATURE [Fingerprint]
N NOTE

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