T4 EaT/ BIRTH REPORT

TT.
FORM No.1
ORIGINAL No.0001641

iftarai afgt statlstlcal Information

a 4Tgdt a5TYA Täi HaATHTS TTafqUura art. Ths part to be detached and send for statistcau pro sing.

fert u-4A ETIA TTA YTAA. To be flled by the

informant
2 6 . 3 Monthg
*************'*************************************
(16) Age of Mother at the time of Marriage..
(10) Residence of the Mother ...MAMBAJ., COLABA (2)ATA T4A ÀA AHgA T4 T
(31) MAr/TBATÀ H (17) Age of Mother at the time of this birth... * *
26. l l Houhs
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * " *

(A) Name of Village/Town.OLADA.. **************

() T a1 TT 3T* (18) Number of Children born alive : * * * ' * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

(B) Is it a Village or Town

************************
KAR (R) FTET (19) Delivered at Type of attention at delivery
(1) Village ****************" (2) Town
(3) 3 7i, ufenfrm arg
*****************

(A) Govenment .. Doctor, Nurse or

(C) Name of Tahsil .MC20AA *********************************
*******************************.

Institution Trained Micwife

(0) Name of District .M1DAI.CET......... () TTUTTE ZTË

B) Private or Non ***************** (E) Traditional . . ****.***************
Government Institution Birth attendant
ALI (E) Name of State AARASI:IAA..
(C) Delivery at. ..(F) Relatives or *****.

i (11) Religion of the Family house or any other place others

(3) fg (R)EKTIM (Ro)yeIR*

(1) Hindu .. 2) Muslim ... (20) Method of Delivery
(3) Rarea (37) zarfe
(3) Christian..

(R) astAfPreT:
4) Sikh (5) Any other Religion. (A) Natural ByCaesarean abkoj
(C) Forcepsvaceum

(12) Father's level of Education . GeM.. (21) Birth Weight S. 23

022

(13) Mother's level of Education.COM. PtL. (22) Duration of Pregnancy .!.O

. . ......- . J . . . i . ***

( ) afseiTqaHT/TEAT:
(14) Father's Occupation R.VIC. (Columns to be filled are over, Now put signature at left).
I (34) Z7H/A:
RUICE
(15) Mother's Occupation.. ****** ***** *

Registration Date...
Registration No. * * * * * * * * * * * * * * * * * * * *
*****************************|

To be filled by the Registrar Date of Birth **************************** ******* ***** **.

i . (AYUAT)
Name Code No. (Census) (1) Male (2) Female
Place Sex
(31) FTUTTAa (a)
(B) House (C) Other Place
District Place of Birth (A) Hospitallnstitution

Tahsil
T/IET
Village/Town
Name, Signature and Seal of Registrar
Registration Unit
n u n munn 269g1 2019.?0:500 BKS O90 X2)