Lakshadweep Gazette, No. 8, 10 May 2024

VOL. LX No.8 THURSDAY, 2nd MAY, 2024 / 12th VAISAKHA, 1946 (SAKA)

the

Administration of Union Territory of Lakshadweep Department of Health Services

Dated:15. 04. 24

NOTIFICATION

F.No. 20/1/2021- DHS (B&D):- In exercise of the powers conferred by section 30 of the Registration of Births and Deaths Act, 1969 (18 of 1969) the Administrator of Union Territory of Lakshadweep with the approval of the Central Government, hereby frames the L a k s h a d w e e p Registration of Births and Deaths (Amendment) Rules, 2024 to amend the Registration of Births and Deaths Rules, 1999, namely: ––

1. (1) Short title: - These rules may be called the Lakshadweep Registration of Births and Deaths (Amendment) Rules, 2024.

(2) They shall come into force with effect from the date of publication in the Official Gazette.

2. In the Lakshadweep Registration of Births and Deaths Rules,

(1999 hereinafter referred to as the principal rules), in t h e rule 5, after sub-rule (3), the following sub-rules shall be inserted, namely:–– ―(4) Name, wherever it occurs, in Forms referred to in Lakshadweep Registration of Births and Deaths (Amendment) Rules, 2024, shall be provided in the format of (first name) (middle name) (last name) and the name shall not contain any abbreviations.

(5) Date, wherever it occurs, in Forms referred to in Lakshadweep Registration of Births and Deaths (Amendment) Rules, 2024, shall be provided in the format of dd-mm-yyyy, where dd is the date in2 THE LAKSHADWEEP GAZETTE EXTRAORDINARY two digits, mm is the month in two digits and yyyy is the year in four digits.

(6) The address, wherever it occurs, in Forms referred to in Lakshadweep Registration of Births and Deaths (Amendment) Rules, 2024, shall contain the name of State or Union Territory, District, Sub- district, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.‖.

3. In rule 7 of the principal rules, ––

(a) in the marginal heading, for the word, figures and brackets ―section 10(3)‖, the words, brackets and figures ―sub-sections (2) and (3) of section 10‖ shall be substituted;

(b) after the words ―certificate as to the cause of death‖, the words ―,including the history of illness, if any,‖ shall be inserted;

(c) for the words, brackets and figure ―sub-section (3)‖, the words, brackets and figures ―sub-sections (2) and (3)‖ shall be substituted;

(d) for the words, figures and letter ―Form No.4 or 4A‖, the words, figures and letter ―Form No. 4 and 4A respectively‖ shall be substituted.

4. In rule 8 of the principal rules, ––

(a) in the marginal heading, for the words ―Extracts of registration entries to be given‖, the words ―Certificate of registration of births or deaths to be given‖ shall be substituted;

(b) in the sub-rule (1), ––

(i) for the words ―extracts of particulars‖, the words ―certificate of birth or death extracted‖ shall be substituted;

(ii) after the words ―given to an informant‖, the words ―,electronically or otherwise,‖ shall be inserted;

(c) for sub-rule (2), the following sub-rule shall be substituted, namely:––

―(2) In the case of domiciliary events of births and deaths, as the case may be, referred to in clauses (a), (aa), (ab) and (ac) of sub-section (1) of section 8 which are reported direct to the Registrar of Births and Deaths, the head of the house or household, as the case may be, or, in his absence, the nearest relative of the head present in the house, or, in his absence, the oldest adult person present, the adoptive parents, the parent, and the biological parent, as the case may be, may obtain electronically or otherwise the certificate of birth or death from the Registrar within thirty days of its reporting.‖;

(d) in sub-rule (3), ––

(i) after the words ―shall transmit‖, the words ―,electronically or otherwise,‖ shall be inserted;

(ii) for the word ―extracts‖, the word ―certificate‖ shall be substituted;

(iii) after the words ―present in the house‖, the words ―or, in his absence, the oldest adult person present,‖ shall be inserted;

(e) in sub-rule (4), ––

(i) for the words, brackets and letters ―births and deaths referred to in clauses (b) to (e)‖, the words, brackets and letters ―births and deaths, as the case may be, referred to in clauses (b) to (e) and (da), (db) and (dc)‖ shall be substituted;

(ii) for the word ―collect‖, the words ―obtain electronically or otherwise‖ shall be substituted;

(iii) for the word ―extract‖, the word ―certificate‖ shall be substituted;

(f) in sub-rule (5), for the word ―extract‖, the word ―certificate‖ shall be substituted.

5. In rule 9 of the principal rules, ––

(a) in sub-rule (1), for the words ―rupee two‖, the words ―twenty rupees‖ shall be substituted;

(b) for sub-rules (2) and (3), the following sub-rules shall be substituted, namely:––

―(2) Any birth or death of which delayed information is given to the Registrar after thirty days but within one year of its occurrence, shall be registered only with the written permission of the District Registrar or Addl. District Registrar on payment of a late fee of fifty rupees and on production of self-attested document, electronically or otherwise, in Form No. 14.

(3) Any birth or death of which delayed information is given to the Registrar after one year of its occurrence, shall be registered only on an Order made by a District Magistrate or Sub-Divisional Magistrate or by an Executive Magistrate authorised by the District Magistrate, having jurisdiction over the area where the birth or death has taken place and on payment of a late fee of one hundred rupees.‖.

6. In rule 12 of the principal rules, after the words and figure ―Forms No.1‖, the figure and letter ―, 1A‖ shall be inserted.

7. In rule 13 of the principal rules, ––

(a) in sub-rule (1),-

(i) for the words ―an extract‖, the words ―a certificate of birth or death‖ shall be substituted;

(ii) for the words and figures ―issued under section 17, shall be as follow‖, the words and figures ―issued under section 17, electronically or otherwise, shall be as follows‖ shall be substituted;

(iii) for the word ―Re.‖, the word ―Rupees‖ shall be substituted;

(iv) for the figures ―2.00‖, wherever it occurs, the figures ―20.00‖ shall be substituted respectively;

(v) in clause (c), ––

(I) for the word ―extract‖, the word ―certificate‖ shall be substituted;

(II) for the figures ―5.00‖, the figures ―50.00‖ shall be substituted;

(b) in sub-rule (2), for the words ―extract in regard to a birth or death shall be issued‖, the words and figures ―certificate on the basis of extract from the register relating to birth or death shall be issued under section 17,‖ shall be substituted;

(c) in sub-rule (4), for the word ―extracts‖, the word ―certificate‖ shall be substituted.

8. In rule 16 of the principal rules, for sub-rule (2), the following sub- rule shall be substituted, namely:––6 THE LAKSHADWEEP GAZETTE EXTRAORDINARY ―(2) Any such offence may be compounded on payment of such sum, not exceeding two hundred and fifty rupees for offences under sub-sections (1), (2) and (4), fifty rupees for offences under sub-section (3), and one thousand rupees in respect of each birth or death for offences under sub-sections (1A) and (4A) of section 23, as the said officer may think fit.‖.

9. After rule 16 of the principal rules, the following rule shall be inserted, namely:––

―16A. Appeal.— An appeal under sub-section (1) of section 25A shall be preferred in Form No. 15.‖.

10. In rule 17 of the principal rules, ––

(a) in sub-rule (2), for the words and figures ―court orders and orders of the specified authorities granting permission for delayed registration received under section 13 by the Registrar‖, the words, brackets and figures ―permission granted under sub-section (2) of section 13 and the orders issued under sub-section (3) of section 13 for delayed registration received by the Registrar‖ shall be substituted;

(b) in sub-rule (3), for the words, brackets and figure ―sub-section (3)‖, the words, brackets and figures ―sub-sections (2) and (3)‖ shall be substituted.

11. In the principal rules, for the Forms 1, 1A, 2, 3, 4, 4A, 5, 6, 7, 8, 9, 10, 11, 12 and 13, the following Forms shall be substituted, namely:– sd/- Sd/- Administrator UT of Lakshadweep

Administrator

UT of Lakshadweep7 THE LAKSHADWEEP GAZETTE EXTRAORDINARY FORM NO.1 " FORM NO.1 (See rule 5) BIRTH REPORT Legal information [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Birth Register

To be filled by the informant

Date of Birth : D D - M M - Y Y Y Y

1.

Sex (Enter "Male" or "Female" or "Transgender person") :

2.

Child's Details (If not named, leave blank) :- Name, if any : First Name Middle Name Last Name 3. (a)

(b) Aadhaar No. (if available):

4. (a)

Father's Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

5. (a)

Mother's Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

6. Address of parents at the time of Birth of the Child: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

7. Permanent address of parents: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

8. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the birth took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

Informant's Details:

Name: First Name Middle Name Last Name 9. (a) (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

(e)

Email Id: Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

(After completing all columns 1 to 22, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village:

Sub-District:

District:

Remarks ( if any):

Name and Signature of the Registrar (See rule 5)

BIRTH REPORT Statistical information [SEE REVERSE FOR INSTRUCTIONS] This part to be detached and sent for statistical processing To be filled by the informant

10. Town or Village of Residence of the mother (Place where the mother usually lives. This can be different from the place where the delivery occurred. Tick appropriate entry "Town" or "Village" and write its name): Town or Village: Sub-district: District: State or Union Territory:

PIN Code:

11.

(a)

For Religion [Enter appropriate religion "Hindu" or Muslim" or "Christian" or "Sikh" or "Buddhist" or "Jain" or "Other (Please specify)"] Religion of Father:

(b)

Religion of Mother:

g n

i

12. Father's level of education:

13. Mother's level of education:

s s e c o

r

p

l

Father's Occupation:

14.

a c

i t

s

Mother's Occupation:

15.

i t

a

t

s

r 16.

o

f

t

Age of the mother (in completed years) at the time of marriage (If married more than once, age at first marriage is to be written):

n e s

17.

d n a

Age of the mother (in completed years) at the time of this birth :

18.

d e h c a

t

Number of children born alive to the mother so far including this child (Number of children born alive to include also those from earlier marriage(s), if any) :

e d

e b

19.

o T

Type of attention at delivery (Tick the appropriate entry below):

1. Institutional-Government 2. Institutional – Private or Non-Government 3. Doctor, Nurse or Trained Midwife 4. Traditional Birth Attendant 5. Relatives or others

20.

Method of Delivery (Tick the appropriate entry below):

1. Natural 2. Caesarean 3. Forceps/Vacuum

21. Birth Weight (in kgs.) (if available) :

22. Duration of pregnancy (in weeks) :

(In the case of multiple births, fill in a separate form for each child and write 'Twin birth' or 'Triple birth' etc., as the case may be, in the remarks column in the box below left.)

(Columns to be filled are over. Now put signature at left)

To be filled by the Registrar Name Code No. District

Sub-District

Town/Village :

Registration Unit :

Registration No. :

Registration Date: D D - M M - Y Y Y Y Date of Birth : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person

Place of Birth: 1. Hospital/Institution 2. House 3. Other place

Name and Signature of the Registrar8 THE LAKSHADWEEP GAZETTE EXTRAORDINARY Instructions for completing the Form 1: BIRTH REPORT

Note: The informant must ensure that no item in the Birth Report Form is left blank to the extent possible.

FORM NO.1-A ( Legal information) (See rule 5) BIRTH REPORT FOR ADOPTED CHILD [SEE REVERSE FOR INSTRUCTIONS]

This part to be added to the Birth Register

To be filled by the informant

Date of Birth : D D - M M - Y Y Y Y

1*.

Sex (Enter "Male" or "Female" or "Transgender person") :

2*.

Child's details (If name is changed on adoption, write new name):- Name of the Child First Name Middle Name Last Name 3. (a)

(b) Aadhaar No. (if available):

4*. (a)

Mother's Details (If known):- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d) Email Id:

5*. (a)

Father's Details(If known):- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

6. (a)

(b)

Details of adoption deed / order:- Date: D D - M M - Y Y Y Y Number of Adoption deed / order:

7. (a)

Adoptive Mother's Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

Email Id:

1

(d) 8. (a)

Adoptive Father's Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

9.

BIRTH REPORT FOR ADOPTED CHILD [SEE REVERSE FOR INSTRUCTIONS]

This part to be detached and sent for statistical processing To be filled by the informant

14. For Religion [Enter appropriate religion "Hindu" or Muslim" or "Christian" or "Sikh" or "Buddhist" or "Jain" or "Other (Please specify)"] Religion of Adoptive Father:

(a)

(b) Religion of Adoptive Mother:

Adoptive Father's level of education:

15.

Adoptive Mother's level of education:

16.

Adoptive Father's Occupation:

17.

g n

i

Adoptive Mother's Occupation:

s s e c o 18.

r

p

l

a c

i t

s

i t

a

t

s

r

o

f

t

n e s

d n a

d e h c a

t

e d

e b

o T

Address of adoptive parents as recorded in Adoption deed / order: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

10.

State or Union Territory: PIN Code: Permanent address of adoptive parents: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

11*. Place of birth: (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the birth took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No. Locality: Ward number (in case of town and if available): Town or Village: Sub-district: District: State or Union Territory: PIN Code:

12. If adoption through agency write the address of the Adoption agency: House No:

Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code: Informant's Details:- Name: First Name Middle Name Last Name 13. (a)

Aadhaar No.(if available):

(b)

Mobile No:

(c)

(d) (e)

Email Id: Address : House No: Locality: Ward number (in case of town and if available): Town or Village: Sub-district: District: State or Union Territory: PIN Code: *As contained in the original birth certificate.

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

(After completing all columns 1 to 18, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village: Sub-District:

District:

Remarks ( if any):

Name and Signature of the Registrar (Columns to be filled are over. Now put signature at left)

To be filled by the Registrar Name Code No. District Sub-District Town/Village :

Registration Unit : Registration No. :

Registration Date: D D - M M - Y Y Y Y Date of Birth : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person

Place of Birth: 1. Hospital/Institution 2. House 3. Other place

Name and Signature of the Registrar10 THE LAKSHADWEEP GAZETTE EXTRAORDINARY Instructions for completing the Form 1-A: BIRTH REPORT FOR ADOPTED CHILD

Note: The informant responsible for reporting birth event of adopted child shall be as per the Registration of Births and Deaths Act, 1969 (amended in 2023). The informant must ensure that no item in the form for Birth Report for Adopted Child is left blank to the extent possible.

FORM NO.2 (See rule 5) DEATH REPORT Legal information [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Death Register To be filled by the informant

1. Date of Death D D - M M - Y Y Y Y

2. (a)

Deceased's Details:- Name: First Name Middle Name Last Name Aadhaar No. (if available):

(b)

Date of Birth (if available) : D D - M M - Y Y Y Y Age:

(c) (d)

Sex (Enter "Male" or "Female" or "Transgender person") :

3.

Mother's Details:- Name: First Name Middle Name Last Name 4. (a)

(b) Aadhaar No. (if available):

(c) Mobile No:

Email Id:

(d)

5. (a)

Father's Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d) Email Id:

6. (a)

Spouse's (husband / wife) Details:- Name: First Name Middle Name Last Name (b)

Aadhaar No.(if available):

(c)

(d)

Date of Birth (if available) : D D - M M - Y Y Y Y Age (in completed years):

Mobile No:

(e)

Email Id:

(f)

7. Address of the deceased at the time of death: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

8. Permanent address of the deceased: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

9. Place of death (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the death took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

Informant's Details:- Name: First Name Middle Name Last Name 10. (a)

(b) Aadhaar No.(if available):

(c) Mobile No:

(d)

(e)

Email Id: Address : House No.: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

To the best of my knowledge and information, the detail of Aadhaar of the deceased is not available. (After completing all columns 1 to 21, informant will put date and signature)

FORM NO.2 (See rule 5) DEATH REPORT Statistical information [SEE REVERSE FOR INSTRUCTIONS] This part to be detached and sent for statistical processing To be filled by the informant

11. Town or village of Residence of the deceased (Place where the deceased usually lived. This can be different from the place where the death occurred. Tick appropriate entry "Town" or "Village" and write its name): Town or Village: Sub-district: District: State or Union Territory:

PIN Code:

12. Religion ( Enter appropriate religion "Hindu" or "Muslim" or "Christian" or "Sikh" or "Buddhist" or "Jain" or "Other (Please specify)"):

Occupation of the deceased:

13.

14.

g n

i

s s e c o

r

Type of Medical Attention received before death (Tick the appropriate entry below): 1. Institutional 2. Medical attention other than Institution 3. No Medical attention

p

l

15.

a c

i t

s

i t

Was the cause of death medically certified? (Tick the appropriate entry below) : 1.Yes 2. No

a

t

s

r 16.

o

f

Name of Disease or Actual Cause of Death (For all deaths irrespective of whether medically certified or not) :

t

n e s 17.

d n a

In case this is a female death, did the death occur while pregnant, at the time of delivery or within 6 weeks after the end of pregnancy (Tick the appropriate entry below): 1.Yes 2. No

d e h c a

t

e d 18. If used to habitually smoke – for how many years?

e b

o T 19. If used to habitually chew tobacco in any form – for how many years?

20. If used to habitually chew arecanut in any form (including pan masala) - for how many years?

21.

If used to habitually drink alcohol - for how many years?

Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant (Columns to be filled are over. Now put signature at left)

To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village:

Sub-District:

District:

Remarks ( if any):

Cause of Death (as per Form 4 / 4A):

Name and Signature of the Registrar

To be filled by the Registrar Name Code No. District

Sub-District Town/Village :

Registration Unit :

Registration No. :

Registration Date: D D - M M - Y Y Y Y Date of Death : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person

Age of deceased:

Place of death : 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar12 THE LAKSHADWEEP GAZETTE EXTRAORDINARY Instructions for completing the Form 2: DEATH REPORT

Note: The informant must ensure that no item in the Death Report Form is left blank to the extent possible.

FORM NO.3 (See rule 5) STILL BIRTH REPORT

Legal information

[SEE REVERSE FOR INSTRUCTIONS]

This part to be added to the Still Birth Register

To be filled by the informant

Date of Birth : D D - M M - Y Y Y Y

1.

Sex (Enter "Male" or "Female" or "Transgender person") :

2.

Father's Details:-

3. (a)

Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

Mother's Details:-

4. (a)

Name: First Name Middle Name Last Name (b)

Aadhaar No.(if available):

(c)

Mobile No:

(d)

Email Id:

5. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the birth took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No. Locality: Ward number (in case of town and if available): Town or Village: Sub-district: District: State or Union Territory: PIN Code:

6. (a)

Informant's Details: Name: First Name Middle Name Last Name (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

(e)

Email Id: Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

(After completing all columns 1 to 12, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village:

Sub-District:

District:

Remarks ( if any):

Name and Signature of the Registrar

FORM NO.3

(See rule 5)

STILL BIRTH REPORT Statistical information [SEE REVERSE FOR INSTRUCTIONS] This part to be detached and sent for statistical processing To be filled by the informant

7. Town or village of Residence of the mother (Place where the mother usually lives. This can be different from the place where the delivery occurred. Tick appropriate entry "Town" or "Village" and write its name): Town or Village: Sub-district: District: State or Union Territory:

PIN Code:

8. Age of the mother (in completed years) at the time of this birth :

Mother's level of education:

9.

g n 10.

i

Type of attention at delivery (Tick the appropriate entry below):

s s e c o

r

p

l

a c

i t

s

1. Institutional-Government 2. Institutional – Private or Non-Government 3. Doctor, Nurse or Trained Midwife 4. Traditional Birth Attendant 5. Relatives or others

i t

a

t

s

r

o

Duration of pregnancy (in weeks) :

f 11.

t

Cause of foetal death (if known):

12.

n e s

d n a

d e h c a

t

e d

e b

o T

(In the case of multiple births, fill in a separate form for each child and write 'Twin birth' or 'Triple birth' etc., as the case may be, in the remarks column in the box below left.)

(Columns to be filled are over. Now put signature at left)

To be filled by the Registrar Name Code No. District

Sub-District

Town/Village :

Registration Unit :

Registration No. :

Registration Date: D D - M M - Y Y Y Y Date of Birth : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person

Place of Birth: 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar14 THE LAKSHADWEEP GAZETTE EXTRAORDINARY Instructions for completing the Form 3: STILL BIRTH REPORT

Note: The informant must ensure that no item in the Still Birth Report Form is left blank to the extent possible.

FORM NO. 4 (See rule 7) MEDICAL CERTIFICATE OF CAUSE OF DEATH (Hospital In-patients. Not to be used for still births) To be sent to Registrar along with Form No. 2 (Death Report) A copy of this certificate to be provided to the nearest relative of the deceased

Name of the Hospital ……………………………………………………………….

I hereby certify that the person whose particulars are given below died in the hospital in Ward No……………………..

Manner of Death How did the injury occur?

1. Natural 2. Accident 3. Suicide 4. Homicide 5. Pending investigation

If deceased was a female, was pregnancy the death associated with? 1. Yes 2. No If yes, was there a delivery? 1. Yes 2. No

Name and signature of the Medical Attendant certifying the cause of death

Date of verification : D D - M M - Y Y Y Y

SEE REVERSE FOR INSTRUCTIONS16 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

MEDICAL CERTIFICATE OF CAUSE OF DEATH

Directions for completing the form

Name of deceased : To be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name]. If deceased is an infant, not yet named at time of death, leave blank.

Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months and if below 1 month give age in completed number of days, and if below one day, in hours.

Cause of Death : This part of the form should always be completed by the attending physician personally.

The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three parts, lines (a) (b) (c). If a single morbid condition completely explains the deaths, then this will be written on line (a) of Part I, and nothing more need be written in the rest of Part I or in Part II, for example, smallpox, lobar pneumonia, cardiac beriberi, are sufficient cause of death and usually nothing more is needed.

Often, however, a number of morbid conditions will have been present at death, and the doctor must then complete the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, respiratory failure, etc. These terms should not be appear on the certificate at all since they are modes of dying and not causes of death. Next consider whether the immediate cause is a complication or delayed result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes there will be three stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be tabulated is always written in last in Part I.

Morbid conditions or injuries may be present which were not directly related to the train of events causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult to decide, especially for infant deaths, which of several independent conditions was the primary cause of death; but only one cause can be tabulated, so the doctor must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II.

Do not write two or more conditions on a single line. Please write the names of the diseases (in full) in the certificates as legibly as possible to avoid the risk of their being misread.

Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., "from birth" "several years".

Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home.

Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for all women of child- bearing age, even though the pregnancy may have had nothing to do with the death.

Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is known. If old age was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age.

Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified.

Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus – Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected.

Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom.

Manner of Death : Deaths not due to external cause should be identified as 'Natural'. If the cause of death is known, but it is not known whether it was the result of an accident, suicide or homicide and is subject to further investigation, the cause of death should invariably be filled in and the manner of death should be shown as 'Pending investigation'.

In accordance with the provisions of section 10(2) of the Registration of Births and Deaths Act, 1969 (amended in 2023), a certificate of cause of death shall be given to the Registrar and a copy of the same to the nearest relative of the deceased.

FORM NO. 4A (See rule 7) MEDICAL CERTIFICATE OF CAUSE OF DEATH (For non-institutional deaths. Not to be used for still births) (To be given to the person required under the Registration of Births and Deaths Act, 1969 (amended in 2023) to give information concerning the death to Registrar along with Form No. 2 (Death Report)

I hereby certify that the deceased Shri/Smt./Km……………………………………………………..Son /Wife/ Daughter of ………………………………resident of ……………………………………….. was under my treatment from ……………………… to ………………………. and he/she died

on D D - M M - Y Y Y Y at…………………….A.M. / P.M.

AM

If deceased was a female, was pregnancy the death associated with? 1. Yes 2. No If yes, was there a delivery? 1. Yes 2. No

Name and signature of the Medical Practitioner certifying the cause of death

Date of verification : D D - M M - Y Y Y Y

SEE REVERSE FOR INSTRUCTIONS18 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

MEDICAL CERTIFICATE OF CAUSE OF DEATH

Directions for completing the form

Name of deceased: To be provided in the following format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name]. If deceased is an infant, not yet named at time of death, leave blank.

Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months and if below 1 month give age in completed number of days, and if below one day, in hours.

Cause of Death : This part of the form should always be completed by the attending physician personally.

The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three parts, lines (a) (b) (c). If a single morbid condition completely explains the deaths, then this will be written on line (a) of Part I, and nothing more need be written in the rest of Part I or in Part II, for example, smallpox, lobar pneumonia, cardiac beriberi, are sufficient cause of death and usually nothing more is needed.

Often, however, a number of morbid conditions will have been present at death, and the doctor must then complete the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, respiratory failure, etc. These terms should not be appear on the certificate at all since they are modes of dying and not causes of death. Next consider whether the immediate cause is a complication or delayed result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes there will be three stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be tabulated is always written in last in Part I. Morbid conditions or injuries may be present which were not directly related to the train of events causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult to decide, especially for infant deaths, which of several independent conditions was the primary cause of death; but only one cause can be tabulated, so the doctor must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II.

Do not write two or more conditions on a single line. Please write the names of the diseases (in full) in the certificates as legibly as possible to avoid the risk of their being misread.

Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., "from birth" "several years".

Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home.

Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for all women of child-bearing age, even though the pregnancy may have had nothing to do with the death.

Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is known. If old age was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age.

Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified.

Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus – Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected.

Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom.

In accordance with the provisions of section 10(3) of the Registration of Births and Deaths Act, 1969 (amended in 2023), a certificate of cause of death shall be given to the person required under this Act to give information concerning the death.

ÑßÑðëð– 5

………….. çðܨîðÜ

State

GOVERNMENT OF ....................

Govt. Emblem ..................वभाग/..(ÑßÙððÂðÑðëð ¸ððÜó ¨îÜÐð÷ ãððâð÷ çÆððÐðóÚðòÐð¨îðÚð ¨îð ÐððÙð)………. DEPARTMENT OF.............../. (Name of local body issuing certificate).....

¸ðÐÙð ÑßÙððÂð-Ñðëð

BIRTH CERTIFICATE

(¸ðÐÙð और ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð ¡òÏðòÐðÚðÙð, 1969 (2023 म संशोिधत) ¨îó ÏððÜð 12 / 17 ÃðÆðð….(Üð¸Úð ¨îð ÐððÙð)..........¸ðÐÙð ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð (संशोधन) òÐðÚðÙð, .. (çðüäðð÷òÏðÃð òÐðÚðÙð ¨îð÷ ¡òÏðçðõòµðÃð ò¨î¦ ¸ððÐð÷ ¨îð ãðæðá)............................¨÷î òÐðÚðÙð 8 / 13 ¨÷î ¡üÃð±ðáÃð ¸ððÜó ò¨îÚðð ±ðÚðð) (Issued under Section 12 / 17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and Rule 8 / 13 of the ..... (Name of State)................... Registration of Births and Deaths (Amendment) Rules............ (Year of notifying the revised rules).

Úðè ÑßÙððòÂðÃð ò¨îÚðð ¸ððÃðð èø क òÐðÙÐðòâðò®ðÃð çðõµðÐðð ¸ðÐÙð ¨÷î Ùðõâð âð÷®ð çð÷ âðó गई èø ¸ðð÷ ò¨î (çÆððÐðóÚð êð÷ëð) ...................................................... ………...... उप-ò¸ðâðð..............................................................................

ò¸ðâðð .................................................................Üð¸Úð ..................................... ¨÷î Üò¸ðç¾Ü Ùð÷ü £òââðò®ðÃð èø | This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local body) .................................................................. of Sub-district ................................ of District .................................of State/Union territory ....................................

ÐððÙð/Name: .......................................................................................... òâðü±ð/Sex................................................................................................ ¸ðÐÙð òÃðòÆð/Date of Birth.......................................................................... ¸ðÐÙð çÆððÐð/Place of birth......................................................................... ÙððÃðð ¨îð ÐððÙð/Name of Mother................................................................ माता का आधार न॰ /Aadhaar No. of Mother: òÑðÃðð ¨îð ÐððÙð/Name of Father .................................................................... िपता का आधार न॰ /Aadhaar No. of Father: ×ðµµð÷ ¨÷î ¸ðÐÙð ¨÷î çðÙðÚð ÙððÃðð òÑðÃðð ¨îð ÑðÃðð / ÙððÃðð òÑðÃðð ¨îð çÆððÚðó ÑðÃðð/ Address of parents at the time of birth of the child : Permanent address of parents: ........................................................... ............................................................ ........................................................... ............................................................ ........................................................... ............................................................ ……………………………………… ………………………………………. Ñðü¸ðó¨îÜÂð çðü®Úðð/Registration No :............. Ñðü¸ðó¨îÜÂð òÇÐððû¨î/Date of Registration................ ò¾ÑÑðÂðó/Remarks (if any)......................... ¸ððÜó ¨îÜÐð÷ ¨îó òÃðòÆð/Date of issue:..............

ÑßðòÏð¨îðÜó ¨÷î èçÃððêðÜ/Signature of the issuing authority ÑßðòÏð¨îðÜó ¨îð ÑðÃðð/ Address of the issuing authority

Ùðð÷èÜ/Seal

ÑßÃÚð÷¨î ¸ðÐÙð ¦ãðÙð þÙðöÃÚðô ¨îð Ñðü¸ðó¨îÜÂð çðôòÐðòäµðÃð ¨îÜ÷ü/ Ensure registration of every birth and death20 THE LAKSHADWEEP GAZETTE EXTRAORDINARY çðü.No.

………….. çðܨîðÜ

GOVERNMENT OF ....................

................वभाग/..(ÑßÙððÂðÑðëð ¸ððÜó ¨îÜÐð÷ ãððâð÷ çÆððÐðóÚðòÐð¨îðÚð ¨îð ÐððÙð)………

State Govt. Emblem

DEPARTMENT OF.............../. (Name of local body issuing certificate).....

ÙðöÃÚðô ÑßÙððÂð Ñðëð

DEATH CERTIFICATE (¸ðÐÙð और ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð ¡òÏðòÐðÚðÙð, 1969 (2023 म संशोिधत) ¨îó ÏððÜð 12 / 17 ÃðÆðð….(Üð¸Úð ¨îð ÐððÙð)..........¸ðÐÙð ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð (संशोधन) òÐðÚðÙð, .. (çðüäðð÷òÏðÃð òÐðÚðÙð ¨îð÷ ¡òÏðçðõòµðÃð ò¨î¦ ¸ððÐð÷ ¨îð ãðæðá)............................¨÷î òÐðÚðÙð 8 / 13 ¨÷î ¡üÃð±ðáÃð ¸ððÜó ò¨îÚðð ±ðÚðð) (Issued under Section 12 / 17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and Rule 8 / 13 of the ..... (Name of State)................... Registration of Births and Deaths (Amendment) Rules............ (Year of notifying the revised rules).

Úðè ÑßÙððòÂðÃð ò¨îÚðð ¸ððÃðð èø क òÐðÙÐðòâðò®ðÃð çðõµðÐðð ÙðöÃÚðô ¨÷î Ùðõâð âð÷®ð çð÷ âðó गई èø ¸ðð÷ ò¨î (çÆððÐðóÚð êð÷ëð) ...................................................... ………...... उप-ò¸ðâðð..............................................................................

ò¸ðâðð .................................................................Üð¸Úð ..................................... ¨÷î Üò¸ðç¾Ü Ùð÷ü £òââðò®ðÃð èø | This is to certify that the following information has been taken from the original record of death which is the register for (local area/local body) .................................................................. of Sub-district ................................ of District .................................of State/Union territory ....................................

ÐððÙð/Name: .................................................................................. ÙðöÃð¨î का आधार न॰ /Aadhaar No. of deceased: òâðü±ð/Sex......................................................................................... ÙðöÃÚðô ¨îó òÃðòÆð/Date of Death............................................................ ÙðöÃÚðô ¨îð çÆððÐð/Place of Death............................................................ ÙððÃðð ¨îð ÐððÙð/Name of Mother.......................................................... माता का आधार न॰ /Aadhaar No. of Mother: òÑðÃðð ¨îð ÐððÙð/Name of Father……………………………………..…..….. िपता का आधार न॰ /Aadhaar No. of Father: पित/पनी का नाम/Name of Husband / Wife……………….………..…...… पित/पनी का नाम/Name of Husband / Wife: ÙðöÃð¨î ¨îð ÙðöÃÚðô ¨÷î çðÙðÚð ¨îð ÑðÃðð/ ÙðöÃð¨î ¨îð çÆððÚðó ÑðÃðð/

Address of the deceased at the time of death: Permanent address of the deceased: ........................................................... ............................................................ ........................................................... ............................................................ ……………………………………..

Ñðü¸ðó¨îÜÂð çðü®Úðð/Registration No :.............Ñðü¸ðó¨îÜÂð दनांक/Date of Registration................ ò¾ÑÑðÂðó/Remarks (if any)......................... ¸ððÜó ¨îÜÐð÷ ¨îó òÃðòÆð/Date of issue:..... ÑßðòÏð¨îðÜó ¨÷î èçÃððêðÜ/Signature of the issuing authority ÑßðòÏð¨îðÜó ¨îð ÑðÃðð/ Address of the issuing authority Ùðð÷èÜ/Seal

ÑßÃÚð÷¨î ¸ðÐÙð ¦ãðÙð þÙðöÃÚðô ¨îð Ñðü¸ðó¨îÜÂð çðôòÐðòäµðÃð ¨îÜ÷ü/ Ensure registration of every birth and death21 THE LAKSHADWEEP GAZETTE EXTRAORDINARY FORM NO.7 (See rule 12) BIRTH REGISTER

Legal information

This part to be added to the Birth Register

To be filled by the informant

Date of Birth: D D - M M - Y Y Y Y

1.

Sex (Enter "Male" or "Female" or "Transgender person") :

2.

Child's Details (If not named, leave blank) :- Name, if any : First Name Middle Name Last Name

3. (a)

(b) Aadhaar No. (if available):

4. (a)

Father's Details:- Name: First Name Middle Name Last Name

(b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

5. (a)

Mother's Details:- Name: First Name Middle Name Last Name

(b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

6.

Address of parents at the time of Birth of the Child: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

7.

Permanent address of parents: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

8.

Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the birth took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code: Informant's Details:

Name: First Name Middle Name Last Name

9. (a) (b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

(e)

Email Id: Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION:

I have furnished true information to the best of my knowledge and belief. I am aware of the penalties

under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting

false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 23, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or

left thumb mark of the informant

To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village:

Sub-District:

District:

Remarks ( if any):

Name and Signature of the Registrar22 THE LAKSHADWEEP GAZETTE EXTRAORDINARY FORM NO.8 (See rule 12)

DEATH REGISTER

Legal information

This part to be added to the Death Register

To be filled by the informant

Date of Death D D - M M - Y Y Y Y

1.

Deceased's Details:- Name: First Name Middle Name Last Name

2. (a)

Aadhaar No. (if available):

(b)

(c)

Date of Birth (if available): D D - M M - Y Y Y Y Age:

(d)

Sex (Enter "Male" or "Female" or "Transgender person") :

3.

Mother's Details:- Name: First Name Middle Name Last Name

4. (a)

Aadhaar No. (if available):

(b)

Mobile No:

(c)

Email Id:

(d)

Father's Details:- Name: First Name Middle Name Last Name

5. (a)

(b) Aadhaar No. (if available):

(c) Mobile No:

Email Id:

(d)

Spouse's (husband / wife) Details:- Name: First Name Middle Name Last Name

6. (a)

(b) Aadhaar No. (if available):

(c) Date of Birth (if available): D D - M M - Y Y Y Y Age (in completed years):

(d)

Mobile No:

(e)

Email Id:

(f)

7.

Address of the deceased at the time of death: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

8.

Permanent address of the deceased: House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

9.

Place of death (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the death took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

10. (a)

Informant's Details:- Name: First Name Middle Name Last Name

(b)

Aadhaar No.(if available):

(c)

Mobile No:

(d)

(e)

Email Id: Address : House No.: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in

2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

To the best of my knowledge and information, the detail of Aadhaar of the deceased is not available.

(After completing all columns 1 to 21, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or

left thumb mark of the informant

To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village: Sub-District: District:

Remarks ( if any):

Cause of death (As per Form 4 / 4A):

Name and Signature of the Registrar23 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

FORM NO.9

(See rule 12)

STILL BIRTH REGISTER

Legal information This part to be added to the Still Birth Register

To be filled by the informant

Date of Birth : D D - M M - Y Y Y Y

1.

Sex (Enter "Male" or "Female" or "Transgender person") :

2.

Father's Details:-

3. (a)

Name: First Name Middle Name Last Name

(b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

Mother's Details:-

4. (a)

Name: First Name Middle Name Last Name

(b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

Email Id:

5.

Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the "Hospital / Institution" or the address of the "House" or 'Other place" where the birth took place) : 1.Hospital / Institution Name :

2. House 3. Other place Address : House No. Locality: Ward number (in case of town and if available): Town or Village: Sub-district: District: State or Union Territory: PIN Code:

6. (a)

Informant's Details: Name: First Name Middle Name Last Name

(b)

Aadhaar No. (if available):

(c)

Mobile No:

(d)

(e)

Email Id: Address : House No: Locality: Ward number (in case of town and if available):

Town or Village: Sub-district: District:

State or Union Territory: PIN Code:

DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication.

(After completing all columns 1 to 12, informant will put date and signature)

Date: D D - M M - Y Y Y Y Signature or

left thumb mark of the informant

To be filled by the Registrar

Registration No. :

Registration Date: D D - M M - Y Y Y Y Registration Unit :

Town / Village:

Sub-District:

District:

Remarks ( if any):

Name and Signature of the Registrar24 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

FORM No.10

(See rule 13)

NON-AVAILABILITY CERTIFICATE (Issued under Section 17 of the Registration of Births & Deaths Act, 1969 (amended in 2023)) This is to certify that a search has been made on the request of Shri/Smt./Kum………………………..……………………………………………. son/wife/daughter of …………..…………………………………………….. in the registration records for the year(s) …………………………. relating to (Local area)…………………………………………………… of (Sub-District) ……………………………………….……….. of (District) ……………….……………. of (State) ………………….……………….. and found that the event relating to the birth/death of ………………………………………… son/daughter of ….……………………………… was not registered.

Date : d d - m m - y y y y

Signature of issuing authority

Seal25 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

FORM No. 11(See rule 14)

SUMMARY MONTHLY REPORT OF BIRTHS

1. Report for the Month of: _____________ Year :_____________

2. District:

3. Town/ Village:

4. Registration Unit:

5. Number of Births Registered during the month:

6. Time Gap in Birth registration:

(a) Within Time limit (21 days) of their occurrence: (b) More than 21 days but within 30 days of their occurrence: (c) More than 30 days but within one year of their occurrence: (d) After one year of their occurrence:

Total* (a + b + c + d):

* Total should be equal to the number of statistical part of Birth Report Forms (Form No.1) attached with this monthly report.

Signature and Name of the Registrar Date : d d - m m - y y y y

Submitted to the Chief Registrar/District Registrar26 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

FORM No. 12 (See rule 14)

SUMMARY MONTHLY REPORT OF DEATHS

1. Report for the Month of: ______________ Year _____________ 2. District:

3. Town/ Village:

4. Registration Unit:

5. Details of Deaths Registered during the Month:

6. Time Gap in Death registration:

(a) Within Time limit (21 days) of their occurrence: (b) More than 21 days but within 30 days of their occurrence: (c) More than 30 days but within one year of their occurrence: (d) After one year of their occurrence:

Total* (a + b + c + d):

Note: Infant and Child Deaths & Maternal Deaths should also be included in the Deaths.

* Total should be equal to the number of statistical part of Death Report Forms (Form No.2) attached with this monthly report.

Signature and Name of the Registrar Date : d d - m m - y y y y

Submitted to the Chief Registrar/District Registrar27 THE LAKSHADWEEP GAZETTE EXTRAORDINARY

FORM No. 13 (See rule 14)

SUMMARY MONTHLY REPORT OF STILL BIRTHS

1. Report for the Month of: _____________ Year :_____________ 2. District:

3. Town/ Village:

4. Registration Unit:

4. Number of Still Births Registered during the month:

5. Time Gap in Birth registration:

(a) Within Time limit (21 days) of their occurrence: (b) More than 21 days but within 30 days of their occurrence: (c) More than 30 days but within one year of their occurrence: (d) After one year of their occurrence:

Total* (a + b + c + d):

* Total should be equal to the number of statistical part of Still Birth Report Forms (Form No.1) attached with this monthly report.

Signature and Name of the Registrar Date : d d - m m - y y y y

Submitted to the Chief Registrar/District Registrar28 THE LAKSHADWEEP GAZETTE EXTRAORDINARY Form No. 14 (See rule 9) Format of Self-attested document for Delayed Reporting of BIRTH / DEATH under Section 13(2) of the Registration of Births and Deaths Act, 1969 (amended in 2023) DECLARATION

I…………………………………………………………,son/daughter/wife of …………….,resident of …………………………………………………………………………. do hereby declare that:

1. I am the informant for the delayed reporting of Birth / Death of_____(name of child / deceased)________________________son/daughter/spouse of ………………………………….; 2. He / she was born / died on ___(date of birth / death)_________________________ at (place of birth / death)…………….; 3. He / she was attended at birth /death by _________________________ who resides at___________; 4. The reason(s) for the delay in reporting of his / her birth /death are _______________________________________________________________________________ _______________________________; 5. His / her birth / death certificate is required for the purpose of ________________________________;

DECLARATION: I, declare that the above information is true and I have not reported the above event to any Registrar and no birth / death certificate has been issued in this respect, to the best of my knowledge and belief.

Name and Signature or thumb mark of the informant

Date D D - M M - Y Y Y Y Notes: 1. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits Wherever the date is written in words it should be written in full e.g 01-01-2023 shall be written as First January two thousand twenty three. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries.

2. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name].

3. Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub- district, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.

Form No. 15 (See rule 16 A) FORM FOR APPEAL (To be submitted to District Registrar / Chief Registrar) (under Section 25(A) of the Registration of Births and Deaths Act, 1969 (amended in 2023))

1. Aggrieved by an action or order of: Registrar / District Registrar or any officer authorized to act as Registrar / District Registrar (details of office to be provided as below)

2. Account of Event Leading to appeal with date and order no. etc. (Provide a detailed account of the occurrence, use attachments, if necessary)

DECLARATION: I have furnished true information to the best of my knowledge and belief.

(Signature of the appellant)

Date D D - M M - Y Y Y Y

-------------------------------------------------------------------------------------------------------------------------------- Notes:

1. Please retain a copy of this form for your own records. 2. Appeal, if any, must be submitted to District Registrar / Chief Registrar within a period of 30 days from the date of such action or receipt of such order with which the person is being aggrieved.

3. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits Wherever the date is written in words it should be written in full e.g 01-01-2023 shall be written as First January two thousand twenty three. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries.

4. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name].

5. Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub-district, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.".

By order of the Governor

(________________________) Secretary to the Government of ………………

LGP.KVT. L-293/5-24/5