APPLICATION FORM FOR ISSUE OF BIRTH CERTIFICATE EXTRACT Corporation of Chennai Health Department From To THE HEALTH OFFICER, Corporation of Chennai, Chennai-600 003. Sir, Please furnish me ------------------------------copy/copies of Birth extract, as as per particulars furnished hereunder: Dated................. Yours faithfully, B. & D. No-------------- Date of Birth---------------- Received Rs.---------------only ACKNOWLEDGEMENT Received an application for the issue of Birth Extract from------------------------------------------ along with the Receipt No.--------------Dt.------------. The party is advised to produce this receipt at this Office and collect the Birth Extract applied for. If the entries are not found the party will be so informed after a thorough search as per the particulars furnished in the application form. Signature
