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C.F No.17
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Cost of Form Rs.2/-
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No.
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Affix Re 1/- Court Fee
Stamp
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Coimbatore Corporation
Application
for issue of Birth Certificate
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From
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To
The Commissioner,
Coimbatore Corporation.
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Sir,
Sub :
Application for Birth Certificate.
I request you to issue
___________________________ copies of Birth Certificates to my male /
female child, as per the particulars furnished below:
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1. Name of the Child
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:
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2. Date of Birth
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:
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3. Sex [Male / Female]
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:
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4. Name of the Father
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:
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5. Name of the Mother
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:
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6. Place of birth, Name of
Hospital / House (Full Address)
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:
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7. Residential Address at the time
of birth
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:
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Date:
Place:
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Signature of the
Applicant
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- Cost of Form :
Rs.2/-
- Cost of Service: Rs.10/-
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NOTE : Register the name of the child
and get the Birth Certificate, with the name of the child.
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