“ FORM NO.1 FORM NO.

1
(See rule 5) (See rule 5)
BIRTH REPORT BIRTH REPORT
Legal information Statistical information
[SEE REVERSE FOR INSTRUCTIONS] [SEE REVERSE FOR INSTRUCTIONS]
This part to be added to the Birth Register This part to be detached and sent for statistical processing

To be filled by the informant To be filled by the informant

1. Date of Birth : D D - M M - Y Y Y Y 10. Town or Village of Residence of the mother (Place

where the mother usually lives. This can be different
2. Sex (Enter “Male” or “Female” or “Transgender person”) : from the place where the delivery occurred. Tick
appropriate entry “Town” or “Village” and write its
3. Child’s Details (If not named, leave blank) :- name):
(a) Name, if any : First Name Middle Name Last Name Town or Village: Sub-district:
(b) Aadhaar No. (if available): District: State or Union Territory:
PIN Code:
4. Father’s Details:-
(a) Name: First Name Middle Name Last Name 11. For Religion [Enter appropriate religion “Hindu” or
(b) Muslim” or “Christian” or “Sikh” or “Buddhist” or “Jain” or
Aadhaar No. (if available):
(c) “Other (Please specify)”]
Mobile No: (a) Religion of Father:
(d) Email Id: (b) Religion of Mother:
5. Mother’s Details:-

To be detached and sent for statistical processing

(a)
Name: First Name Middle Name Last Name 12. Father’s level of education:
(b)
Aadhaar No. (if available): 13. Mother’s level of education:
(c)
Mobile No:
(d)
Email Id: 14. Father’s Occupation:

6. Address of parents at the time of Birth of the Child: House No: 15. Mother’s Occupation:
Locality: Ward number (in case of town and if available):
Town or Village: Sub-district: District: 16. Age of the mother (in completed years) at the time
State or Union Territory: PIN Code: of marriage (If married more than once, age at first
marriage is to be written):
7. Permanent address of parents: House No:
Locality: Ward number (in case of town and if available): 17. Age of the mother (in completed years) at the time
Town or Village: Sub-district: District: of this birth :
State or Union Territory: PIN Code:
18. Number of children born alive to the mother so far
8. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of including this child (Number of children born alive to
the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took include also those from earlier marriage(s), if any) :
place) :
1.Hospital / Institution Name : 19. Type of attention at delivery (Tick the appropriate
2. House 3. Other place Address : House No: entry below):
Locality: Ward number (in case of town and if available): 1. Institutional-Government
Town or Village: Sub-district: District: 2. Institutional – Private or Non-Government
State or Union Territory: PIN Code: 3. Doctor, Nurse or Trained Midwife
4. Traditional Birth Attendant
9. Informant’s Details: 5. Relatives or others
(a) Name: First Name Middle Name Last Name 20. Method of Delivery (Tick the appropriate entry below):
(b)
Aadhaar No. (if available): 1. Natural
(c) 2. Caesarean
Mobile No: 3. Forceps/Vacuum
(d)
Email Id:
(e)
Address : House No: 21. Birth Weight (in kgs.) (if available) :
Locality: Ward number (in case of town and if available):
Town or Village: Sub-district: District: 22. Duration of pregnancy (in weeks) :
State or Union Territory: PIN Code:
DECLARATION:
I have furnished true information to the best of my knowledge and belief. I am aware of the penalties
under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting
false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other
Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar
authentication. (In the case of multiple births, fill in a separate form
for each child and write 'Twin birth' or 'Triple birth'
(After completing all columns 1 to 22, etc., as the case may be, in the remarks column in
informant will put date and signature) the box below left.)

Date: D D - M M - Y Y Y Y Signature or (Columns to be filled are over. Now put signature at left)
left thumb mark of the informant

To be filled by the Registrar To be filled by the Registrar

Name Code No.
Registration No. : District
Registration Date: D D - M M - Y Y Y Y
Sub-District
Registration Unit :
Town / Village: Town/Village :
Sub-District: Registration Unit :
District: Registration No. :
Remarks ( if any): Registration Date: D D - M M - Y Y Y Y

Date of Birth : D D - M M - Y Y Y Y

Sex : Male / Female / Transgender person

Place of Birth: 1. Hospital/Institution 2. House 3. Other
place

Name and Signature of the Registrar Name and Signature of the Registrar
 Instructions for completing the Form 1: BIRTH REPORT

Item No. Instructions

1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm
is month in two digits and yyyy is year in four digits. Wherever the date is written in words it should
be written in full e.g 01-01-2023 shall be written as First January two thousand twenty three. Use
only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries.
2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation.

3,4,5,9 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name]
where full name (not abbreviation) to be written in capital letters and first name is mandatory. There
should be minimum two characters in either [first name] or [middle name] or [last name]. If child is
not named, leave blank.
Birth can be registered without name of the child. However, name of child can be inserted, free of
charge, within 12 months of registration (Refer Rule 10 of State Rules).
6,7,8,9 Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub-district,
Town or Village, Ward number (in case of town and if available), Locality, House number and PIN
Code.
8 Tick the appropriate entry for place of birth
1. Hospital / Institution
2. House
3. Other place
Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other
place” where the birth took place.
10 Town or Village of residence of the mother: Place where the mother usually lives. This can be
different from the place where the delivery occurred. The house address is not required to be
entered.
12,13 Level of Education – Write one of following—
1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without
Primary Undergraduate formal education

2.Class 1 7.Class 6 12.Class 11 17. PG Diploma 22. Illiterate

3.Class 2 8.Class 7 13.Class 12 18. Master / Post
graduate
4.Class 3 9.Class 8 14.ITI 19. M.Phil
5.Class 4 10.Class 9 15.Diploma / 20. Doctorate & above
Certificate
(Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write
class VI)
14, 15 Occupation - Write one of following—
1. Cultivator
2. Agriculture Labourer
3. Daily Wages Earner(Other than Agriculture Labourer)
4. Single/Family Worker/Self Employed
5. Employer
6. Government Employee
7. Private Employee(Other than Domestic Helper)
8. Domestic Helper
9. Non-Worker

Note: The informant must ensure that no item in the Birth Report Form is left blank to the extent possible.