Meeseva GHMC Birth and Death Correction Form

Meeseva GHMC Birth and Death Correction Form

Download Meeseva GHMC Birth and Death Correction Form

CIRCLE / LOCATION:__________________

DECLARATION FOR CORRECTIONS OF BIRTH AND DEATH ENTRIES
I,______________________________________S/o_____________________
_____________Aged about_______ years working as ________________
(Designation and complete address of the individual of the firm)
Residing at __________________________________________________________
___________________ (Complete Door No. Street and Station has to be stated with
_____________________________Delievred Male child/F
emale child___________________________________________________________________
(Actual place of event) on ________________________
_______________ (date of issued on _________________________
The name/s was wrongly informed by _______________________(the person who
Event has to be stated) please do the following correction
eSeva Transaction No.

The following documents should be produced by the d
eclarant for name corrections in
Birth/Death Registers:
1. Declaration by the nearest either father or mother in case of liver Birth
2. The declaration stated should be true and corret by of Gazetted Officers are to be written in
3. Notary Affidavit on (Rs.10/
4. The Original Birth / Death Certificates already
taken are to be returned
5. Documentary Evidences like Educational Certifica
tes, Election ID Card, Ration Card,
Passport,Driving Licenses, Marriage Certific
Property Papers, etc.,(Evidence to be submitted bef
ore Birth of the Child or Death of the
Deceased)
6. Consent Letter from the concerned Hospital regar
ding the correction to the effect
7. Other Child Certificates if a
8. In case of Medico Legal Death a) FIR b) Post Mor
tem Report c)Form_2 by concerned
Police Station
9. Any other support documents if any please specify.

I know Sri/Smt____________________________________
S/o/W/o______________________________________ as a resident of__________________
_______________ _____The signature of the declarant is taken in my presence and the contents mentioned by the Declarant are true and correct to the best of my knowledge and belief.
2. GAZETTED OFFICER
Sign & Seal &
(Name of the Officer)
eSeva Transaction Date:
The following documents should be produced by the declarant for name corrections in relative (Parents/Children’s/Spouse) in case of death and either father or mother in case of liver Birth
2. The declaration stated should be true and correct by two Gazetted Officers of Gazetted Officers are to be written in CAPITALS( Non Judicial Stamped Paper).
4. The Original Birth / Death Certificates already taken are to be returned
5. Documentary Evidences like Educational Certificates, Election ID Card, Ration Card, Passport,Driving Licenses, Marriage Certificate, LIC Policies, Caste Certificates,
Property Papers, etc.,(Evidence to be submitted before Birth of the Child or Death of the
6. Consent Letter from the concerned Hospital regarding the correction to the effect
7. Other Child Certificates if any
8. In case of Medico Legal Death a) FIR b) Post Mortem Report c)Form_2 by concerned
9. Any other support documents if any please specify.