Schedule–12
( Related with Rule
7 ) Government of
Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya
Municipality
Bardiya,
District
Birth Registration Certificate
Registration No. ……… Date of Registration ……………..
Family Record Form No
This is to certify, as per the birth register maintained at this office and
the information provided by by Mr./ Mrs . ……………. in the information from of
schedule 2, that Mr/Mrs……………. Son/Daughter of Mr …………. and
Mrs...............................................................................................................................................................
,
grandson/grand daughter of Mr/Mrs …………. , a resident of Ward No …,..........,
was born on …………… BS (...............AD ) at home.
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's :
A. Father :…………………….. Signature :
B. Mother : ………… Name and surname:
Date : …………
Schedule–13
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya Municipality
Bardiya, District
Death Registration Certificate
Registration No. ….. Date of Registration ……….
Family Record Form No.
This is to certify, as per the death register maintained at this office and the information
provided by Mr./ Mrs ………. in the information from of schedule 3 , that Mr/Mrs ………… aged
…. ,son /daughter of Mr/Mrs …………. , grandson/granddaughter of Mr/Mrs …………… ,
Husband / wife of Mr/Mrs
………….. a resident of Ward No ……., ……………………died on ………… Bs (...........AD ) .
If Citizenship Certificate is Issued to the deceased : Local registrar's:
His/Her Citizenship Certificate No. : ………. Signature :
Date and District of issuance :…………… Name and
surname : Date :
…………..
Schedule–14
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya
Municipality
Bardiya,
District
Marriage Registration Certificate
Registration No. …… Date of Registration ……….
Family Record Form No.
This is to certify, as per the marriage register maintained at this office and the information
provided by Mr
………… and Mrs ………… in the information from of schedule 4, that Mr/Mrs ………. , aged
…… , son of Mr ………, grandson of Mr/Mrs ……………a resident of Ward No. Gulariya
Municipality , Bardiya
District , married Mrs ………, aged …. , daughter of Mrs ………. , granddaughter of Mr/Mrs. , a
resident of Ward No ….. ,………, on …… Bs ( ………. AD ) in accordance with the social
customs..
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's:
A. Bride : ………….. Signature :
B. Bridegroom : Name and surname :…………………
Date : ……………….
Schedule–15
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya Municipality
Bardiya, District
Divorce Registration Certificate
Registration No. ………. Date of Registration ……..
Family Record Form No.
This is to certify, as per the divorce register maintained at this office and the information
provided by Mr./ Mrs . in the information from of schedule 5, that the marital relationship
between Mr.
, aged , son of Mr grandson of Mr. ,,
a resident of Ward No. Gulariya Municipality , Bardiya District , and Mrs. , aged ,
daughter of Mr. , granddaughter of Mr. , a resident of
Ward No
…Gulariya Municipality,Bardiya district, was terminated on as per the judgement of the
court
,dated ………Bs (...........AD )
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's:
A. husband : Signature :
B. wife : Name and surname :
Date :…………
Schedule–12
( Related with Rule
7 ) Government of
Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya
Municipality
Bardiya,
District
Birth Registration Certificate
Registration No. …… Date of Registration ……….
This is to certify, as per the birth register maintained at this office and the
information provided by Mr./ Mrs ………. in the information from of schedule
2, that Mr./Miss …… son /daughter of Mr ……………. and Mrs. ……..,
grandson/granddaughter of Mr./Mrs. ……… , a resident of Ward No …, Gulariya
Municipality,Bardiya district, was born on ……….. Bs( AD ) at home.
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's :
A. Father :……….. Signature :
B. Mother : ………. Name and surname: …………….
Date : …………
Schedule–13
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya Municipality
Bardiya, District
Death Registration Certificate
Registration No. …. Date of Registration …….
Family Record Form No.
This is to certify, as per the death register maintained at this office and the information
provided by Mr./ Mrs ……. in the information from of schedule 3 , that Mr./Miss …….. aged 33
,son /daughter of Mr/ Mrs
……….. , grandson/granddaughter of Mr./Mrs. …….. , Husband / wife of Mrs …… a resident of
Ward No ….. Gulariya Municipality,Bardiya district, died on …………. Bs ( AD ) .
If Citizenship Certificate is Issued to the deceased : Local registrar's:
His/Her Citizenship Certificate No. : ……… Signature :
Date and District of issuance : …………….. Name and
surname : Date :
……..
Schedule–14
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya
Municipality
Bardiya,
District
Marriage Registration Certificate
Registration No. ….. Date of Registration ………
Family Record Form No.
This is to certify, as per the marriage register maintained at this office and the information
provided by Mr.
………. and Mrs. ………… in the information from of schedule 4, that Mr. ……….. , aged …. ,
son of Mr
……….., grandson of Mr. ……… a resident of Ward No. 3 Deudhakala V.D.C. , Bardiya District ,
married
Miss ……….., aged ….. , daughter of Mr.........., granddaughter of Mr........., a resident of Ward
No
… ,Gulariya Municipality Bardiya district, on ………. Bs (.............AD ) in accordance with the
social
customs..
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's:
A. Bride : …………. Signature :
B. Bridegroom : Name and surname : …………
Date : ………….
Schedule–15
( Related with Rule 7 )
Government of Nepal
Ministry of Federal Affairs and Local Development
Office of Local Registrar
Gulariya Municipality
Bardiya, District
Divorce Registration Certificate
Registration No. ……. Date of Registration ………
Family Record Form No.
This is to certify, as per the divorce register maintained at this office and the information
provided by Mr./ Mrs /Mrs. in the information from of schedule 5, that the marital
relationship between Mr.
, aged , son of Mr grandson of Mr. ,, a
resident of Ward No. Gulariya Municipality , Bardiya District , and Mrs. , aged ,
daughter of Mr. , granddaughter of Mr. , a resident of
Ward No 1 Gulariya Municipality,Bardiya district, was terminated on as per the judgement of
the court
,dated 2040/1/15 Bs ( 1999january 5 AD )
Date, District and Citizenship No.if Citizenship Certificate is Issued to : Local registrar's:
A. husband : Signature :
B. wife : Name and surname :
Date : ……..
