Cdma Birth Corrections Application Form
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CDMA Birth
CDMA Birth Corrections Application Form
Birth Details
:-
District: __________________________
__________________________ Registration Unit Id: _____________________________________
_____________________________________
Registration Number: _______________
_______________ Registration Year: _____________ Birth Year: _________________
_________________
Location:
Greater Municipality
Municipality
Municipality
Municipal Corporation
Gram Panchayat
Gender:
Male
Female
Corrections Required in Birth Certificate
Certificate Details
:-
Yes
No
Whether You Want to Update Child Name:
You Want to Update Child Name:
Changed Child Surname: ___________________
___________________ Changed Child Name: _____________________________
_____________________________
Yes
No
Whether You Want to Update Date of
Birth:
Changed Date of Birth: _________________________
_________________________
Yes
No
Whether You Want to Update Gender:
Whether You Want to Update Gender:
Male
Female
Changed Gender:
Yes
No
Whether You Want to Update Father Name:
Whether You Want to Update Father Name:
Changed Father Surname: ____________________ C
____________________ Changed Father Name: ___________________________
___________________________
Yes
No
Whether You Want to Update Mother Name
Whether You Want to Update Mother Name:
Changed Mother Surname: ___________________ C
___________________ Changed Mother Name: ___________________________
___________________________
Yes
No
Whether You Want to Update Birth Place:
Whether You Want to Update Birth Place:
Changed Birth Place: ___________________________
___________________________
Yes
No
Whether You Want to Update Address a
her You Want to Update Address at the Time of Birth:
Changed Line 1 of Address at the Time
Time of Birth: _________________________________________________
Birth: _________________________________________________
Changed Line 2 of Address at the Time
Time of Birth: _________________________________________________
Birth: _________________________________________________
Changed Line 3 of Address at the Time
he Time of Birth: _________________________________________________
rth: _________________________________________________
Yes
No
Whether You Want to Update Permanent
Permanent Address:
Changed Line 1 of Permanent Address: ________________________________________________________
Address: ________________________________________________________
Address: ________________________________________________________
Changed Line 2 of Permanent Address:
Address: ________________________________________________________
________________________________________________________
Changed Line 3 of Permanent Address: ________________________________________________________
Address: ________________________________________________________
Address: ________________________________________________________
Informant Details:-
Informant Name: _____________________________________________________________________
_________________________________________________________________________
_____________________________________________________________________
S/o
D/o
w/o
w/o
H/o
M/o
F/O
C/o
Informant Relation:
Informant Address1: ______________________________________________________________________
: ______________________________________________________________________
: ______________________________________________________________________
Informant Address2: ______________________________________________________________________
: ______________________________________________________________________
: ______________________________________________________________________
Informant Address3: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Mobile Number: ____________________
____________________ Email ID: ______________________________________________
______________________________________________
Remarks: _______________________________________________________________
_______________________________________________________________________________
________________
Manual / In Person
Post – Local
Post
Post - Nonlocal
Pin code: ___________________ Delivery
Delivery Type:
Purpose of the Certificate ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
No of copies: ________________
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