శనివారం, సెప్టెంబర్ 17, 2011

Still Birth Report

FORM NO. 3
(SEE RULE - 5)
Still Birth Report
Registration Unit/Villages/Town /Municipality/Taluk/Tahsil/Block/Thana . . . . . . . .
District.
1. Date Of Birth
2. Sex Male/Female
3. Place Of Birth
4. Permanent Residential Address of Parent
5. Father’s
I. Name
II. Literacy
III. Occupation
IV. Nationality
V. Religion
6. Mother’s
I Name
II Literacy
III Occupation
IV Nationality
V Religion
7. Age of mother in completed years at confinement
8. Type of attention at delivery
9. Informant’s
I. Name
II. Address
Date:-
Signature of left thumb
Mark of the informant.
Note: - If the person is non-worker, insert the word “Nil” in the column for occupation

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