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Avcbvi wkï‡K wUKv w`b

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XvKv wmwU Ki‡cv‡ikb


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Child’s Name Sex


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Child’s Father’s Name Religion


3| wkïi gvZvi bvg ag©
Child’s Mother’s Name Religion
4| wkïi wcZvi ¯’vqx wVKvbv
Permanent Address of Child’s Father
5| wkïi wcZvi eZ©gvb wVKvbv
Present Address of Child’s Father
6| wkïi wcZvg‡ni ( `v`v ) bvg I wVKvbv
Child’s Grand Father’s ( Paternal ) Name & Address
7| Rb¥ ZvwiL Rb¥ msev` `v‡bi ZvwiL
Date of Birth Date of Birth Reporting
8| Rb¥ ¯’vb m¤ú~Y© wVKvbv mn
Place of Birth with Full Address
9| msev` `vZvi bvg, wVKvbv I m¤úK©

ev‡bvqvU Z_¨ cÖ`vb 1983Bs m‡bi Rb¥ / g„Zy¨ wbeÜxKiY


Rb¥ / g„Zy¨ msµvšÍ D‡Ïk¨cÖ‡Yvw`Z †h †Kvb fzj / AmZ¨ /
Name & Address of the Reporter & Relation
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AvB‡bi 10 aviv †gvZv‡eK `Êbxq Aciva|


K)

L)

11| gšÍe¨ ( hw` _v‡K )

we‡kl `ªóe¨ t
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weeiYvw` c~iY KiZt AÎ wefv‡M Rgv w`‡Z nB‡e ( wkïi
Rb¥ †Kvb †gwWK¨vj/ wK¬wb‡K nB‡j D³ †gwWK¨vj/ wK¬wb‡Ki msev``vZvi ¯^vÿi Ges ZvwiL
mZ¨vwqZ mvwU©wd‡KU mshy³ Kwiqv w`‡Z nB‡e|) Signature of the Reporter & Date
L| wkïi R‡b¥i 90 w`‡bi D‡a© nB‡j wbgœwjwLZ Z_¨vw` ‡ck Kwi‡Z nB‡e
1| †gwWK¨vj mvwU©wd‡KU ( hw` †gwWK¨vj / wK¬wb‡K Rb¥ nBqv _v‡K )|
2| hw` †gwWK¨vj mvwU©wd‡KU bv _v‡K A_©vr Rb¥ †Kvb †gwWK¨vj / wK¬wb‡K bv nq
Z‡e ïay gvÎ 10 bs Kjv‡gi `yBRb mvÿxB h‡_ó|
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4| Gm, Gm, wm mvwU©wd‡K‡Ui mZ¨vwqZ d‡UvKwc (hw` nBqv _v‡K)|
5| cvm‡cvU© Gi mZ¨vwqZ d‡UvKwc (hw` cvm‡cvU© nBqv _v‡K)|
1
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2
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