________________________

_____________ _________________/

Applicant Name _____________________________________

_____________________________________

Applicant CNIC No. _________________________________

_______________________________

Childs Name ______________________________________

____________________________________________

Relation of Child with applicant________________________

_______________________________

Religion ___________________________________________

_____________________________________________

Fathers Name ______________________________________

____________________________________________

Fathers CNIC No. __________________________________

_____________________________________

Mothers Name_____________________________________

___________________________________________

Mothers CNIC No. _________________________________

____________________________________

District of Birth ____________________________________

________________________________________

Vaccinated

Yes

No

Disability __________________________________________

___________________________________________

Date of Birth _______________________________________

________________________________________

Registration Date____________________________________

________________________________________

Gender____________________________________________

_____________________________________________

Address ___________________________________________

______________________________________________

__________________________________________________

________________________________________________

Grand Fathers Name _________________________________

___________________________________________

Grand Fathers CNIC No.______________________________

_____________________________________

Doctor / Mid wifes Name_____________________________

_______________________________________/

Applicants Signature / Date ___________________________

____________________________/

Verified By ________________________________________

_________________________________________

THE ENTRY OF THE SAID DATE IS ACCORDING TO THE STATEMENT FURNISHED BY THE INFORMING PERSON/INSTITUTION.
This extract to Mr. /Mrs. ________________________________________ has been issued vide application dated ________________
Rs. __________ regarding fees for the registration/extract has been received vide receipt no. ____________ dated ________________
Book No. ___________ Entry No. __________________ Dated: ____________

Signature of UC Secretary ___________________

Checked by______________ SD________

Birth, Deaths, Marriages and Divorces

(Name & Signatures)

Union Administration _____________(No.___________)

Date of Issuance: ____________________

CRMS No.