2961

Panaji, 3rd March, 2022 (Phalguna 12, 1943)

SERIES I No. 49

Reg. No. RNP/GOA/32/2021-2023

RNI No. GOAENG/2002/6410

PUBLISHED BY AUTHORITY

Suggestions are welcomed on e-mail: dir–[email protected]

NOTE

There is a Extraordinary issue to the Official Gazette, Series I No. 48 dated 24-2-2022 namely, Extraordinary dated

24-2-2022 from pages 2959 to 2960, Notification No. 5-2-2021-Fin (DMU) from Department of Finance regarding Market

Borrowing Programme of State Government 2021-22.

INDEX

Department

Notification

Subject

Pages

Planning, Statistics &

Not.- DPSE/RBD/Amendment-

The Goa Registration of Births and

2961

Evaluation

-Rule/2020/312

Deaths (Amendment) Rules, 2021.

Dir. & ex officio Jt. Secy.

GOVERNMENT OF GOA

Department of Planning

Directorate of Planning, Statistics & Evaluation &

Office of the Chief Registrar of Births & Deaths

––

Notification

DPSE/RBD/Amendment-Rule/2020/312

In exercise of the powers conferred by

section 30 of the Registration of Births and

Deaths Act, 1969 (Central Act No. 18 of 1969),

the Government of Goa, with the approval of

the Central Government, hereby makes the

following rules so as to further amend the

Goa Registration of Births and Deaths Rules,

1999, namely:—

1. Short title and commencement.— (1)

These rules may be called the Goa

Registration

Births

and

Deaths

(Amendment) Rules, 2021.

(2) They shall come into force on the

date of their publication in the Official

Gazette.

2. Amendment of rule 10.— In the Goa

Registration of Births and Deaths Rules, 1999

(hereinafter referred to as the “principal

Rules”), in rule 10, for sub-rule (1), the

following sub-rule shall be substituted,

namely:—

“(1) Where the birth of any child has

been registered without a name, the parent

NOTE

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2962

or guardian of such child shall, within a period of 12 months from the date of registration

of the birth of child, give information regarding the name of the child to the Registrar either

orally or in writing:

Provided that such information may be given,—

(I) after the aforesaid period of 12 months but within a period of 15 years,

(II) after the aforesaid period of 15 years, but within a period of 05 years from the date

of commencement of the Goa Registration of Births and Deaths (Amendment) Rules, 2021,—

(i) in case where the registration had been made prior to the date of commencement

of these rules (principal rules 1999); Or

(ii) in case where the registration had been made after the date of commencement of

these rules (principal rules 1999) and 15 years period from the date of registration has

already been lapsed,

subject to the provisions of sub-section (4) of section 23, the Registrar shall,—

(a) if the register is in his possession forthwith enter the name in the relevant column

of the concerned form in the birth register on payment of a late fee of rupees five;

(b) if the register is not in his possession and if the information is given orally, make a

report giving necessary particulars, and if the information is given in writing, forward the

same to the Officer specified by the Government in this behalf for making the necessary

entry, on payment of a late fee of rupees five.”.

3. Amendment of rule 13.— In rule 13 of the principal rules, for sub-rule (1), the following

sub-rule shall be substituted, namely:—

“(1) The fees payable for a search to be made, and extract or a non-availability certificate

to be issued under section 17, shall be as follows:—

(a) Search for a single entry in the first year for which the

Rs. 5.00

search is made

(b) For every additional year for which the search is continued

Rs. 5.00

Rs. 25.00

(d) For granting non-availability certificate of Birth or Death

Rs. 25.00”

4. Substitution of Forms.— In the principal rules, for the existing Form Nos. 1, 2, 3, 5, 6,

7, 8, and 9, the following forms shall be respectively substituted, namely:—

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2963

Form No.1

(See rule 5)

Form No.7

(See rule 12)

BIRTH REGISTER

ENDORSEMENT

No. (.....)

BR ………

BIRTH REPORT

Legal Information

This part is to be added to the Birth Register

BIRTH REPORT

Statistical Information

This part to be detached and sent for statistical processing

FORM No. 1

In the case of multiple births, fill in 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.

To be filled by the Informant:

To be filled by the informant:

1. Date of Birth: (Enter the exact day,

month and year the child was born

e.g. 01-01-2000)

10. Town or village of residence of the mother: (Place where the

mother lives. This can be different from the place where the

delivery occurred. The house address is not required to be entered):

16. Age of the mother (in completed years) at the

time of marriage: (if married more than once,

age at first marriage may be entered):

2. Sex: (Enter “Male, Female or Transgender”, ……………….………...…..

do not use abbreviation)

a) Name of Town/Village:

17. Age of the mother (in completed years) at

the time of this birth:

3. Name of the Child, if any: ……………………………………………..…

(If not named, leave blank)

To be detached and sent for statistical processing

b) Is it a Town or Village? (Tick the appropriate entry below):

4. Name of the Father: ……………………………………………………....

(full name as usually written)

(1) Town (2) Village

18. 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]:

5. Name of the Mother: ……………………………………………………….

(full name as usually written)

c) Name of District:

d) Name of State:

19. Type of attention at delivery: (Tick the appropriate entry

below):

5a. Permanent address of Parents: …………………………………..…...

11. Religion of the Family (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

5b. Address of Parents at the time of birth of Child: …………….….....

(1) Hindu (2) Muslim (3) Christian

6. Name of Grandfather (father’s side): ……………………………….……

(4) Any other religion: (Write the name of the religion):

7. Name of Grandmother (father’s side): …………………………………..

12. Father’s level of education: (Enter the completed

level of education e.g. if studied upto Class VII but

passed only class VI, write class VI)

8. Place of birth: ………………………………………………..………..…….

(Tick the appropriate entry 1 or 2 below and give

the name of the Hospital/Institution or the

address of the house where the birth took place).

13. Mother’s level of education: (Enter the completed level

of education e.g. if studied upto class VII but passed only

class VI, write class VI).

1) Hospital/Institution Name: ……………………………………………….

2) House Address: ……………………………………………………………

14. Father’s occupation:

(If no occupation write ‘Nil’).

15. Mother’s occupation:

(If no occupation write ‘Nil’).

9. Informant’s Name: …………………………………………….….…………

Address: …………………………………………………………….………..

(After completing all columns 1 to 22,

Informant will put date and signature here):

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

22. Duration of pregnancy (in weeks):

Date: (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 :

Name Code No.

Registration No.: Registration date:

Registration Unit : District :

District :

Date of Birth:

Town/Village :

Tehsil :

Sex: (1) Male (2) Female (3) Transgender

Remarks (if any) :

Town/Village :

Place of Birth: (1) Hospital/Institution (2) House

……………………………………

Registration Unit :

Name and signature of the Registrar

(Name and signature of the Registrar)

“

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2964

Form No.2

(See rule 5)

ENDORSEMENT

No. (…..)

DR ……..

Form No.8

(See rule 12)

DEATH REGISTER

DEATH REPORT

Legal Information

This part is to be added to the Death Register

DEATH REPORT

Statistical Information

This part to be detached and sent for statistical processing

FORM No. 2

To be filled by the Informant:

To be filled by the informant:

1. Date of Death: (Enter the exact day,

month and year the death took place

e.g. 01-01-2000)

11. Town or village of residence of the deceased: (Place

where the deceased actually lived. This can be different from

the place where the death occurred. The house address is not

required to be entered):

15. Was the cause of death medically certified? (Tick

the appropriate entry below):

2. Name of the deceased: ……………………..

(Full name as usually written)

a) Name of Town/Village:

(1) Yes (2) No

3. Sex of the deceased: …………………………………………

(Enter “Male, Female or Transgender” do not use abbreviation)

To be detached and sent for statistical processing

b) Is it a Town or Village? (Tick the appropriate entry below):

16. Name of disease or actual cause of death (For all deaths

irrespective of whether medically certified or not):

4. Name of the Mother: ………………………………………………..

5. Name of the Father: ………………………………………………….

5a. Name of Husband/Wife:…………………………………………

(1) Town (2) Village

17. 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):

5b. Age of Husband/Wife: ……………………………………..

c) Name of District:

d) Name of State:

(1) Yes (2) No

5c. Contact details of Husband/Wife: ………………………………..

12. Religion (Tick the appropriate entry below):

18. If used to habitually smoke-

for how many years?

19. If used to habitually chew

tobacco in any form-for how

many years?

20. If used to habitually chew

arecanut in any from (including

pan massala)- for how many

years?

21. If used to habitually drink

alcohol- for how many years?

(Columns to be filled are over.

Now put signature at left).

6. Age of the deceased: ……………………………

(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 1 day, in hours).

(1) Hindu (2) Muslim (3) Christian

7. Address of the deceased at the time of Death: ………………………….

(4) Any other religion: (Write the name of the religion):

8. Permanent address of the deceased: …………………………………….

13. Occupation of the deceased:

(If no occupation write ‘Nil’)

9. Place of Death: ……………………………………………………….

(Tick the appropriate entry 1, 2 or 3 below and give the name

of the Hospital/Institution or the address of the house

where the death took place. If other place give location).

14. Type of medical attention received before death:

(Tick the appropriate entry below).

1) Hospital/Institution Name & Address: ……………………………………….

2) House Address: ……………………………………………………

3) Other place: …………………………………………………….

1) Institutional:

2) Medical attention other than institution:

3) No medical attention:

10. Informant’s Name: …………………………………………………

Address: ……………………………………………………………..

(After completing all columns 1 to 21,

Informant will put date and signature here):

Date: (Signature or left thumb mark of the informant)

To be filled by the Registrar:

Registration No. : Registration date :

Name Code No.

Registration No.: Registration date:

Registration Unit : District :

District :

Date of Death: …… Age: ……. years/months/days/hours.

Town/Village :

Tehsil :

Sex: (1) Male (2) Female (3) Transgender

Remarks (if any) :

Town/Village:

[Place of Death: (1) Hospital/Institution (2) House (3) Other

place]

……………………………………………

Name and signature of the Registrar

Registration Unit :

Name and signature of the Registrar

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2965

Form No.3

(See rule 5)

Form No.9

(See rule 12)

STILL BIRTH REGISTER

STILL BIRTH REPORT

Legal Information

This part is to be added to the Still Birth Register

STILL BIRTH REPORT

Statistical Information

This part to be detached and sent for statistical

processing

To be filled by the Informant:

To be filled by the informant:

1. Date of Birth: (Enter the exact day,

month and year e.g. 01-01-2000)

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. The house address is not required to be entered):

2. Sex: (Enter “Male, Female or Transgender”, ……………………..

do not use abbreviation).

a) Name of Town/Village:

3. Name of the Father: …………………………………………

(Full name as usually written)

To be detached and sent for statistical processing

b) Is it a Town or Village? (Tick the appropriate entry below):

4. Name of the Mother: …………………………………………

(full name as usually written)

(1) Town (2) Village

5. Place of Birth: ……………………………………………….

(Tick the appropriate entry below and give

the name of the Hospital/Institution or the

address of the house where the birth took place).

c) Name of District:

d) Name of State:

1) Hospital/Institution Name: ………………………………..

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

2) House Address: …………….............................................

9. Mother’s level of education:

(Enter the completed level of education e.g. if studied

upto class VII but passed only class VI, write class VI).

6. Informant’s Name: ……………………………………………..

Address: ………………………………………………………….

(After completing all columns 1 to 12,

Informant will put date and signature here):

10. 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:

Date: (Signature or left thumb mark of the informant)

11. Duration of pregnancy (in weeks):

12. Cause of Foetal death (if known):

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

To be filled by the Registrar

Registration No.: Registration date:

Name Code No.

Registration No.:

Registration date:

Registration Unit:

District:

Date of Birth:

Town/Village: District::

Tehsil :

Sex: (1) Male (2) Female (3) Transgender

Remarks (if any):

Town/Village:

Place of Birth: (1) Hospital/Institution (2) House

……………………………………………

Registration Unit:

Name and signature of the Registrar

(Name and signature of the Registrar)

FORM No. 3

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

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2968

Form No. 7

(See rule 12)

BIRTH REGISTER

BIRTH REPORT

Legal Information

This part is to be added to the Birth Register

To be filled by the Informant

1. Date of Birth: (Enter the exact day,

month and year the child was born

e. g. 01-01-2000)

2. Sex: (Enter “Male, Female or Transgender”, ……………………………..……

do not use abbreviation)

3. Name of the child, if any: ………………………………………………..…

(If not named, leave blank)

4. Name of the father: ………………………………………………………...

(Full name as usually written)

5. Name of the mother: ……………………………………………………….

(Full name as usually written)\

5a. Permanent address of Parents: ……………………………………………..…...

5b. Address of Parents at the time of birth of Child: ………………………………

6. Name of Grandfather (father’s side): ……………………………………...……

7. Name of Grandmother (father’s side): …………………………………..………

8. Place of birth: …………………………………………………………….….…...

(Tick the appropriate entry 1 or 2 below and give

the name of the Hospital/Institution or the address

of the house where the birth took place).

1) Hospital/Institution Name: …………………………………..………………

2) House Address: ……………………………………………….…………..….

9. Informant’s Name: …………………………………………………………….…

Address: …………………………………………………………………..………

(After completing all columns 1 to 22,

informant will put date and signature here:)

Date: (Signature or left thumb mark of the informant)

To be filled by the Registrar

Registration No.:

Registration Date:

Registration Unit:

District:

Town/Village:

Remarks: (If any)

…………………………………………

Name and Signature of the Registrar

ENDORSEMENT

No. (…..)

DR ……..

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2969

Form No. 8

(See rule 12)

ENDORSEMENT

DEATH REGISTER

No………. DEATH REPORT

DR………. Legal Information

(This part is to be added to the Death Register)

To be filled by the informant

1. Date of Death: (Enter the exact day,

month and year the death took place

e.g. 01-01-2000)

2. Name of the deceased: ………………………………………………………

(Full name as usually written)

3. Sex of the deceased: ……………………………………………………………………

(Enter “Male, Female or Transgender” do not use abbreviation)

4. Name of Mother: ………………………………………………………….

5. Name of Father: …………………………………………………………….

5a. Name of Husband/Wife: …………………………………………………………...

5b. Age of Husband/Wife: …………………………………………………………….

5c. Contact details of Husband/Wife: ……………………………………………….

6. Age of the deceased: …………………………………………………………………

(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 1 day, in hours).

7. Address of the deceased at the time of Death: …………………………………………

8. Permanent address of the deceased: ……………………………

9. Place of Death: …………………………………………………………

(Tick the appropriate entry 1, 2 or 3 below and give the name

of the Hospital/Institution or the address of the house

where the death took place. If other place give location).

1) Hospital/Institution Name & Address: ……………………………………….......

2) House Address: ……………………………………………………….…

3) Other place: ………………………………………………………………

10. Informant’s Name: …………………………………………………

Address: ……...…

(After completing all columns 1 to 21,

informant will put date and signature here):

Date:

(Signature or left thumb mark of the informant)

To be filled by the Registrar

Registration No.:

Registration Date:

Registration Unit:

Town/Village:

District:

Remarks (if any):

…..……………………………………..

Name and Signature of the Registrar

OFFICIAL GAZETTE — GOVT. OF GOA

SERIES I No. 49

3RD MARCH, 2022

2970

Form No. 9

(See rule 12)

STILL BIRTH REGISTER

STILL BIRTH REPORT

Legal Information

This part to be added to the Still Birth Register

To be filled by the informant

1. Date of Birth:

(Enter the exact day, month and year

e.g. 1-1-2000).

2. Sex: (Enter “Male, Female or Transgender”, ……………………………………………………………

Do not use abbreviation).

3. Name of the Father: ………………………………………………………………………………………

(Full name as usually written)

4. Name of the Mother: ………………………………………………………………………………….…..

(Full name as usually written)

5. Place of birth: ………………………………………………………………………………………….….

(Tick the appropriate entry below and give the

name of the Hospital/institution or the address

of the house where the birth took place).

1. Hospital/Institution Name: ………………………………………………………………………..……

2. House Address: ………………………………………………………………………………..………

6. Informant’s Name: ……………………………………………………………………………..……...…

Address: ……………………………………………………………………………………………..……

(After completing all columns 1 to 12,

informant will put date and signature here):

Date:

Signature or left thumb mark of the informant

To be filled by the Registrar

Registration No.:

Registration Date:

Registration Unit:

Town/Village:

District:

Remarks (if any):

…………………………………………………….

Name and Signature of the Registrar

”.

By order and in the name of the Governor of Goa.

Dr. Y. Durga Prasad, Director/Chief Registrar of Births & Deaths.

Porvorim, 25th February, 2022.

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