FORM -1
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BIRTH REPORT Legal Information |
BIRTH REPORT Statistical
information |
In the case of multiple births, fill in a separate form for each child
and write Twin birth or Triple birth etc. as then case may be, in the
remarks column in the box below left. |
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To be filled by the informant 1.Date of birth(enter the exact day,month & year
the..................................................... child was born e.g.
1.1.2000) 1.
Sex(Enter male or female)........................................ (do
not use abbreviations) 2.
Name of the child, if any......................................... (if
not named, leave blank) 3.
Name of the father.................................................. (full
name as usually written) 4.
Name of the mother................................................ (full
name as usually written) 5.
Place of birth:(Tick the appropriate entry 1or 2 below and give the
name of the hospital / inst
itution or the address of the house where the birth took place)
Institution
6.
Informant’s
Name....................................................... Address (After completing all. columns 1
to 20, informant will put date & signature here) Date
Signature or left thumb mark of the informant |
To be filled by the informant 8.Town or village of Residence of the mother(Place where the mother
actually lives. This can be different from the place where the delivery
occurred. The house address is not required to be entered) a)
Name of Town/Village............................ b)
Is it a town or village (Tick the appropriate entry below) 1.
Town
2. Village.............. c)
Name of District..................................... d)
Name of State.......................................... 9. Religion of the family(Tick the appropriate entry below) 1. Hindu
2.Muslim
3.Christian 4. Any other religion(write name of the religion) 10.Father’s level of
education........................................ (Enter the completed
level of education e.g. if studied upto Class VII but passed
only Class VI, write VI) 11. Mother’s level of
education........................................ (Enter the completed
level of education e.g. if studied upto Class VII but passed
only Class VI, write VI) 12.
Father’s occupation...........................................
13.
Mother’s occupation........................................
( if no occupation write nil) |
To be filled by the informant 14.
Age of the mother (in completed years) at the time Of
marriage........................................ (if
married more than once,age at first marriage may be entered) 15.
15. Age of the mother (in completed years) at the time
of this birth........................................ 16.
Number of children born alive to the .................... Mother
so far including this child(Number of children born alive to include also
those from earlier marriage(s), if any.) 17.
Type of attention at delivery : (Tick the appropriate entry below)
18.
Method of Delivery: (Tick the appropriate entry below)
19.
Birth Weight (in Kgs) (if available): 20.
Duration of pregnancy ( in weeks) : |
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To be filled by the Registrar Registration No.
Registration Date : Registration Unit: Town/ Village
District
: Remarks :if any Name
& Signature of the Registrar |
To be filled by the Registrar
Name
Code No. District : Tahsil : Town/Village : Registration Unit : |
To
be filled by the Registrar Registration No.
Registration Date: Date of Birth : Sex : 1. Male
2. Female Place of Birth 1. Hospital/Institution 2. House Name and Signature of the Registrar |