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Birth and Death Corrections (New) - CDMA

This document is a declaration form for correcting birth and death entries, requiring personal information from the declarant and details about the event. It outlines the necessary documents needed for the correction process, including declarations from relatives, affidavits, and original certificates. Additionally, it mandates verification by two gazetted officers and specifies other supporting documents that may be required.

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242 views2 pages

Birth and Death Corrections (New) - CDMA

This document is a declaration form for correcting birth and death entries, requiring personal information from the declarant and details about the event. It outlines the necessary documents needed for the correction process, including declarations from relatives, affidavits, and original certificates. Additionally, it mandates verification by two gazetted officers and specifies other supporting documents that may be required.

Uploaded by

pavankalyan000079
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Circle/Location: ___________________________________

Declaration for corrections of Birth and Death entries

I _____________________________________ S/O ___________________________________________

___________________ Aged about _________________ Years, working as _______________________________

(Designation and complete address of the individual of the firm) residing at

_____________________________________________________________________________________________

(Complete Door No. street and station has to be stated with Telephone number)

Declared that

I/My ____________________________________ Delivered Male child/ Female child

Born/Died in ____________________________ (actual place of event) on ____________________

(Date of Event)_______________________________________

The Birth /Death certificate Issued on __________________________________________________________

The Name/s was wrongly informed by ________________________________ (The person who informs the

event has to be stated) please do the following corrections

In correct Name To be corrected as

STATION: ___________

Date: _________________ SIGNATURE OF THE DECLARANT

(Declarants Name in Capital Letters)


I Know Sri/Smt _________________________________________________________________________

S/O W/O______________________________________________________________________________

as a resident of _______________________________________________________________________

The signature of the Declarant is taken in my presence and contents mentioned by the Declarant are true and
correct to the best of my knowledge and belief.

1. 2.

GAZETTED OFFICER GAZETTED OFFICER

Sign &Seal & Sign &Seal &

(Name of the officer) (Name of the officer)

CSC Transaction No. CSC Transaction No.

The following Documents should be produced by the Declarant for name corrections in Birth/Death registers.

1. Declaration by the nearest relative (parents/Childs/spouse) in case of death and either father or mother in
case of live Birth.

2. The declaration stated should be true and correct by two Gazatted officers (names of Gazatted officers are to
be written in Capitals)

3. Notary affidavit on (Rs. 10/. Non judicial Stamped paper).

4. The original Birth/ Death certificates already taken are to be returned.

5. Documentary evidences like educational certificates , election ID card, Ration card, passport, Driving Licenses,
Marriage certificate, LIC policies, caste certificates, property papers, etc (evidence to be submitted before birth
of the child or Death of Deceased )

6. Consent letter from concerned Hospital regarding the correction to the effect.

7. Other child certificates if any.

8. In case of Medico Legal death a) Post mortem report b) Form – 2 by concerned police station

9. Any other support Documents if any please specify.

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