Schedule-2

(Relating to Rule 5)

Birth Notification Form

(To be filled by the informer)

The Local Registrar,

Ward No————————-Rural Municipality/Municipality.

————————————-District, —————-Province

Dear Sir,

I have come to give information of the birth of the baby, setting out the following details. It is requested that the birth be registered according to the law.

• Details of the baby

First Name:_______    Middle Name: ______   Surname: _________

Date of Birth: [B.S] (yy/mm/dd) _________       [A.D] (dd/mm/yy)  ___________

Birth Place [Infant]:   House _____    Health Institute:_______ Hospital: ______Other:_______

Gender: Male  ____  Female:______ Other:________

Address of birth place:

State:    ___                                Rural /Municipality:    ______                 Ward No:_______

If born abroad, address (in Nepal:  District, Province, Local-Address)

Type of Birth: Single       Twins ___    Three or more than three babies________

Weight of the baby: (In Gram)___________ Not Measured [Weight Not Measured]_________

Helper at the time of birth of the baby  _______      Doctor   ___  Nurse   __           Qualified attendant_____

Disabled (If Any) _____________

• Information on grandfather of the baby:

First Name ______Middle Name   ______    Last Name__________

• Information of father and mother of the baby:

Father’s first Name _____ Middle Name ______ Last Name _________

Mother’s First Name _______   Middle Name  _______  Last Name___________

Covenanting that the details mentioned herein are true and correct, and if proved false, I shall bear and pay, I, the informer, hereby sign:

The informer’s details:

First name                                      Middle name                                Surname

Relationship with the baby

Citizenship (if Nepali)

Citizenship certificate no./identification no.

If foreigner, passport number in Nepali:

Name of the country of issue:

If foreigner, passport number in English:

Name of the country of issue:

Date when form filled up:(Y- M- D)

To be filled up by the Local Registrar

Documents to be attached:

1. Copy of father or mother’s citizenship certificate:
2. Report of birth issued by the health institution/hospital if born there:
3. If born at the house, evidence of the last vaccination:
4. In the absence of evidence of the hospital or vaccination, to get the person of whom birth registration is required to be registered to appear in person or document issued by the concerned Ward certifying the birth of the person of whom birth registration is required to be registered,
5. In the case of foreigner, copy of father’s and mother’s passport or evidence showing residence in the concerned Ward,
6. In the case of an Indian citizen, evidence wetting out the identity that he or she is Indian citizen,
7. If the father is disappearing or his whereabouts are not known, the letter of police in that respect.