Declaration For Corrections S Of Birth And Death Entries printable pdf download

Circle/Location: ___________________________________

Declaration for corrections of

Declaration for corrections of Birth and Death entries

Death entries

I _____________________________________ S/O ___________________________________________

___________________ Aged about _________________

___________________ Aged about _________________ Years, working as _______________________________

Years, working as _______________________________

(Designation and complete address of the individual of the firm) residing at

_____________________________________________________________________________________________

(Complete Door No. street and station has to be stated with

on has to be stated with Telephone number)

Declared that

I/My ____________________________________ Delivered Male child/ Female child

Born/Died in ___________________________

Born/Died in ____________________________ (actual place of event) on ____________________

place of event) on ____________________

(Date of Event)_______________________________________

_______________________________________

The Birth /Death certificate Issued on __________________________________________________________

The Name/s was wrongly informed by ________________________________ (

The Name/s was wrongly informed by ________________________________ (The person who informs the

he person who informs the

event has to be stated) please do the following corrections

as to be stated) please do the following corrections

In correct Name

To be corrected as

STATION: ___________

Date: _________________

SIGNATURE OF THE DECLARANT

(Declarants Name in Capital Letters)

Declaration For Corrections S Of Birth And Death Entries