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State

Hospital

Government Name

सरकार का नाम

Top Left No. in Local Language

Top Right No. in Local Language

Department Name

विभाग का नाम

Hospital Name

अस्पताल का नाम

Birth Certificate in Local Language - जन्म प्रमाण पत्र - स्थानीय भाषा मे

लाइन नंबर 1

Line no. 1

लाइन नंबर 2

Line no. 2

Name in Local Language

Gender in Local Language

Date Of Birth in Local Language

Place Of Birth in Local Language

Mother Name in Local Language

Father Name in Local Language

ADDRESS OF PARENTS AT THE TIME OF BIRTH OF THE CHILD [ Local Language ]

PERMANENT ADDRESS OF PARENTS

NAME OF HUSBAND / WIFE [ Local ]

HUSBAND / WIFE AADHAAR NO [ Local ]

AGE OF DECEASED [ LOCAL ]

REGISTRATION NUMBER in Local Language

DATE OF REGISTRATION in Local Language

Remarks in Local Language

DATE OF Issue in Local Language

ISSUING AUTHORITY in Local Language

Registrar in Local Language

Registrar

Hospital Stamp in Local Language

Hospital Name as on Stamp

Aadhar Number in Local Language

Last Line in Local Language

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Form Logo

Add Signature

Add Stamp

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