ANNEXURE VII

                                                            ................. Town Panchayat

 APPLICATION FOR ISSUE OF BIRTH CERTIFICATE

From

Thiru/Tmt.

 To

The Executive Officer,

...........................................Town Panchayat

 Sir,

                                       Sub:- Application for birth certificate

                                                                ---

          I  request  that ...... copy/copies of  certificate  of birth  of  the male/female baby, the details of which  are  given below may be issued. 

1. Name of the child                             : 

2. Date of Birth                                    : 

3. Sex                                                : 

4. Name of the Father                          :

5. Name of the Mother                         :

6. Place of birth, Hospital,                   :
   House with address 

7. Residential address at the
   time of delivery of the baby               : 

8. Purpose for which the
   certificate is required                       : 

9. Relationship of the applicant
   to the child                                     : 

10.Details of fees paid                        :     Amount Rs.

                                                              Receipt No.     date.

Place:

Date:

Note: Register the name of the child and get the certificate with the name of the baby

                                                                                            Signature of Applicant 

 ACKNOWLEDGEMENT 

                                                                                       ............................Town Pt.

                                                                                         Sl.No.... Date......

                The   application   for  birth    certificate   from  Thiru........... has been received
on ...........  He is informed to  contact   the  Executive Officer  regarding  the  application
on.......  (after 10 days).  His application has been  registered as Sl.No.......in the register
maintained for this purpose.

                                                                                                     Executive Officer,

                                                                                           ..............Town Panchayat