This document contains a birth registration form providing details of a child's birth. It includes information such as the child's name and sex, parents' names and addresses, place and date of birth, delivery details such as location and weight, and basic demographic information about the parents such as occupation, education level, and age of the mother. The form was filled out by the child's father as the informant and will be registered by the local registrar.

1. To be filled by the informant To be filled by the informant To be filled by the informant
1. Date of Birth : 24/12/2022 10. Town or Village of
Residence of the mother :
16. Age of the mother(in completed
years) at the time of marriage:
21
2. Sex : Female a) Name of State : GUJARAT 17. Age of the mother(in competed
years) at the time of the birth:
23
3. Name of the child : / b) Name of District : Mahesana 18. Number of children born alive to
the mother so far including this
child :
1
4. Name of the father : ˆDbWĥI5ȳkĥOhDs^kishanji chanduji thakor c) Name of Taluka Visnagar Female : 1
5. Name of the mother: 8bhZpWOhDs^ashaben thakor d) Name of Town or
Village :
Tarabh Male : 0
6. Address of Parents
at the time of Birth
of the Child
OhDs^^hU°aahdOhD^hdWXhNRȤkK^hSthakor
,ramdevvas,thakrasan,patan,gujarat
e) Is it a Town or
Village :
Village 19. Type of attention at Delivery : Institutional ±Private, Non
Government
7. Permanent
address of parents :
OhDs^^hU°aahdOhD^hdWXhNRȤkK^hSthakor
,ramdevvas,thakrasan,patan,gujarat
11. Religion of the Family : Hindu 20. Method of Delivery : Natural
8. Place of Birth : Shakti Multispeciality Hospital 12. Father's level of
education :
Below Primary 21. Birth Weight(in kgs.): 1.61
Address : 5/6/85/1-S TO 23-S 2ND FLOOR SURBHI
ARCADE, SIDDHPUR
13. Mother's level of
education :
Below Primary 22. Duration of Pregnancy(in weeks) : 9
9. Informant 's name : kishanji chanduji thakor 14. Father's occupation : Farmers, Fishermen, Hunters,
Loggers etc. and Related workers
Birth application no : 4663945
Address : thakor ,ramdevvas,thakrasan,patan,gujarat 15. Mother's occupation : Non-workers
Birth application no : 4663945
Date : Signature or left thumb mark of the informant (Columns to be filled are over. Now put signature at left)
To be filled by the Registrar To be filled by the Registrar
Registration No : Registration Date : State : Gujarat Code No. Registration No :
Registration Unit: Siddhpur(M) District : Patan Registration Date :
Town/Village: Siddhpur(M) Tahsil: Sidhpur Date of Birth : 24/12/2022
District : Patan Town/Village : Siddhpur(M) Sex : Female
Remarks : Registration Unit: Siddhpur(M) Place of Birth: Shakti Multispeciality Hospital
Name and Signature of the Registrar Name and Signature of the Registrar
Courtesy : National Informatics Center Print Time :-12/24/2022 11:30:32 AM
Form No. 1 Form No. 1
This part to be added to the Birth Register
Legal information
In the case of multiple births, fill in a separate form for each
child and write 'Twin birth' or 'Triple birth' etc., as the case
may be, in the remarks column in the box below left
Birth Application No : 4663945
BIRTH REPORT BIRTH REPORT
Statistical information
This part to be detached and sent for statistical processing