ENGLISH EXTRACT TRANSLATION OF __________________ LANGUAGE
BIRTH CERTIFICATE
Name of Registered Child: __________________________________________
Date of Birth:
__________________________________________
Place of Birth:
__________________________________________
Father of Child:
__________________________________________
Age of Father:
__________________________________________
Nationality of Father:
__________________________________________
Mother of Child:
__________________________________________
Age of Mother:
__________________________________________
Nationality of Mother:
__________________________________________
PATERNAL GRANDPARENTS ______________________________________
______________________________________
MATERNALGRANDPARENTS ______________________________________
______________________________________
PLACE and DATE REGISTERED: ____________________________________
____________________________________
Volume, Page and Number:
____________________________________
Name of Judge (if delayed registration): ______________________________
WITNESSES: _____________________ & ____________________________
DATE & PLACE THIS COPY ISSUED: ________________________________
I, ______________________________, attest to my competency to translate from
___________________________ to English, and I certify that this is a correct English
translation of all pertinent information from the _______________________ original.
____________________________________
Date: _______________________