Form No : 24H No. : To The Chief Municipal Health Officer The Kolkata Municipal Corporation Required a certified extract from the Birth Register in respect of the following : 1. Name of Child : 2. Sex: 3. Name of Mother : 4. Name of Father : 5. Place of Birth : 6. Date of birth : 7. Date of Registration : 8. No of copies required : 9. Fee paid Rs : Signature of Applicant Name : Address : Date :
