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BIRTH REGISTRATION APPLICATION
DATE:12/Mar/2010 User Name :  internet
Registration No:
Registered Number:   Ward:    Zone :    
Child Detail's:
Date Of Birth: Place Of Birth:  
Living Children No: Hosiptal /Residence :
Child's Surname: Child's Name:
Gender: Religion:
Mother's Address: Father's Address:
Mother's Detail's :
Mother's Surname: Mother's Name:
Mother Town /Village: Name Of Town/Village:
Mother Education: Mother Occupation:
District of Town/Village: State Of Town/Village:
Age At Birth: MarriageAge:   
Father's Detail's:
Father's Surname: Father's Name:
Father Occupation: Father Education:
Informer Details:
Informer Name: Door.No:
Street: Locality :
emailID: Phone.No :
Delivery Detail's :
 BirthWeight in kgs : Pregnancy Duration in weeks:
Delivery Method: Delivery Attention: