To

The District Registrar,

Births and Deaths,
District_________________.
Subject: -

Request for Birth Certificate.

Sir,
Kindly issue me_________copies of birth certificate as per particulars are
given below:1.

Date of Birth

__________________________________________

2.

Name of Child

__________________________________________

3.

Sex (Male/Female)

__________________________________________

4.

Place of Birth

__________________________________________

5.

Name of Father

__________________________________________

6.

Name of Mother

__________________________________________

7.

Permanent Address

__________________________________________

8.

Birth order

__________________________________________

Thanking you,
Yours faithfully,

Name _______________
Adderss _____________
Total amount of Rs._____________
Receipt No.____________________

Dated_________________