Application Form
Late Registration of Birth
To
The Revenue Divisional Officer.
Division,
District.
Respected Sir,
son/daughter-regarding.
Sub: - Request for Issue of the my
Birth Certificate of
F/O M/O
I, D/O
S/O
W/O
Age R
Ankule
years, R/o H.No. c0 Near S
occupation: following few
Podu) Mandal, uke n Dist. Andhra Pradesh submit the
l1nes for your kind perusal and sympatheticfaworable consideration pea
o years and my
That my wife's name is Deey chinnalkk aAge
son daughter Drari Anja e (dd/mm/yyyy) in
was born on
Delivery at H.No. o Mandal/Municipality,
NeanLmmafi alap
uam Dist. Andhra Pradesth. The information regarding birth of my son/daughter
was not infomed to the local Births and Deaths Registration Authority of
Mandal/Municipality. Hence the name of my son /daughter is not recorded n
the Birth &Death Register of Pa ) TLdMandal/Municipality.
That my son/daughter requires birth certificate for further education urgently.
Ienclosed here with Non availability certificate issucd by the GP or Municipal
Commissioner, Ration card copy, SSC marks memoand SelfAffidavit.
Therefore I request you kindly to issue necessary orders to Commissioner, Municipal
Council to record date of birth of my son/daughter and issue Birth
Certificate as
above at the earliest.
Contact Details:
Landline Number:
Mobile No:
Yours faithfully,
E-Mail ID:
Signature of the Applicant
(13% soáO)
peda Ankud
DaraOI Baiaiah
20 2)
Baiaiah
taiari Anai
otfh e
Oifice Grama
Markapur Hdi;
0W ANCHAYATSECRETARY
Jammafapalii Grana Panchayat
PrakasamDist.
erkapu ilnndal:
Borro-560001
1947, Jo, www.uldalD.gov.ln uldal.gov.in help 1947 180 1800
1947
Www
23329
523329 Pradesh, Andhra
Prakasam,Jammanapalle, Palle, sO,
£91 Ltb8 SLO8 Jammana Peddulu, S/Address:
O e, s/o :
MTNORIVORANDIA
