CERTIFICATE OF BIRTH
Translation
CERTIFICATE OF BIRTH
Registration Office: Form Thor.Ror.19 Part 1
|No. Hor. 12799/20 |
|1. |1.1 Name : |Surname : |1.2 Sex : |1.3 Nationality : |
|The | | |[ ] Male [ ] Female | |
|New Born | | | | |
| |1.4 Date of Birth Day/Month/Year |At : |Corresponding to : |Month : |Year : |
| | | |[ ] Waxing Moon | | |
| | |hrs. |[ ] Waning Moon | | |
| |1.5 Place of birth: House No., Village No., Alley, Road, Sub-District, District, Province |Country : |
|2. |2.1 Name : |Maiden name : |2.2 Age: |2.3 Nationality : |
|Mother | | |Years | |
| |2.4 Residing at the same place as the |House No., Village No., Alley, Road, Sub-District, District, Province |
| |new born : [ ] | |
|3. |3.1 Name : |Surname : |3.2 Age : |3.3 Nationality : |
|Father | | |Years | |
|4. Person |4.1 Name : |Surname : |4.2 Residence: House No., Village No., Alley, Road, Sub-District, District Province |
|Notifying | | | |
|Birth | | | |
| |4.3 Relationship : |4.4 Signature of notifying person : |
| |[ ]Head of Household, [ ]Father, [ ]Mother, [ ]Officer, [ ]Midwife, [ ]Other | |
|5. Date of notification : Day / Month / Year |6. Date of notifying name changed : Day / Month / Year |
|7. Signature of Registrar : |8. Signature of Registrar acknowledging name changed : |
|- signed - | |
|( ) |..………………………… |
| |(……………………………) |
|(Official seal affixed) |Registrar ...…………………………… |
Certified correct translation
Signed ………………………………….
( )
Translator
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