|
Manually |
Online |
* Date of Birth
Date/month/year (eg., 21/12/1987 ) |
* Date of Birth
Select
 Date
Calender |
* Sex
Male or Female |
* Sex
Select option Male or Female |
Name of the Child
Full Name of child |
Name of the Child
Full Name of child |
* Father's Name
Child's Father Name |
* Father's Name
Child's Father Name |
* Mother's Name
Child's Mother Name |
* Mother's Name
Child's Mother Name |
Place of Birth --
If it is inHospital , mention Hospital Name
If it is in Home , mention Home Address
If it is in some other location, mention the location specifications |
Place of Birth --
If it is in Hospital , Select Hospital and enter Hospital Name
If it is in Home , Select Home and enter Home Address
If it is in some other location, Select Others and enter the location specifications
in Other Specify |
Informer Name and Address
Name of the Applicant and Present Address of the applicant
|
Applicant Details
Name of the Applicant and Present Address of the applicant
|
Mother's residing place city/village
Name of city or Name of Village and Name of the Taluk |
Mother's residing place city/village
Select Area Name
|
Religion
Religion of Mother |
Religion
Select religion of mother, if other enter in Others Specify |
Education of Father
Father qualifications |
Education of Father
Father qualifications |
Education of Mother
Mother qualifications |
Education of Mother
Mother qualifications |
Occupation of Father
Father work details |
Occupation of Father
Father work details |
Occupation of Mother
Mother work details |
Occupation of Mother
Mother work details |
At the time of marriage age of mother
Age of Mother at the time of Marraige |
At the time of marriage age of mother
Age of Mother at the time of Marraige |
At the time of delivery age of mother
Age of Mother at the time of child's delivery |
At the time of delivery age of mother
Age of Mother at the time of child's delivery |
Number of children born to Mother
Total number of children born to mother including
the newly born baby |
No of children born to Mother
Total number of children born to mother including
the newly born baby |
Place of Delivery
Name of place where delivery happened |
Place of Delivery
Select the name of place where delivery happened |
Way or Process of delivery
The way the child has been delivered by mother |
Way or Process of delivery
Select the
way the child has been delivered by mother |
At the time of Birth Weight of child
Weight of child in Kilograms at the time
of delivery |
At the time of Birth Weight of child
Weight of child in Kilograms at the time
of delivery |
Period of Pregnancy in weeks
Total number of weeks of mother's pregnancy of the
child |
Period of Pregnancy in weeks
Total number of weeks of mother's pregnancy of the
child |