Notification, 2025

Text

Reproduced from the document India Code holds for this instrument. The Gazette prints Hindi and English side by side and this is the English; the Department's own PDF remains the authority.

RAJASTHAN GAZETTE

Extraordinary Magha 18, Friday, Saka 1946- February 07, 2025 (see rule 8 and 13)

GOVERNMENT OF RAJASTHAN

DIRECTORATE OF ECONOMICS AND STATISTICS

Name of local area/body issuing certificate

BIRTH CERTIFICATE

(Issued under section 12/17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and rule 8/13 of the Rajasthan Registration of Births and Deaths Rules, 2000 (amended in 2025)). This is to certify that the following information has been taken from the original record of birth which is the register of (local area/local body) ……………………………………………………… of Sub-district/Tehsil ………………………………………… of District ………………………………………………. of State/Union Territory ………………………………………………… Address of parents at the time of birth of child Permanent address of parents ् ्‍ पि/Remarks (if any) ………………………………………….

(see rule 8 and 13)

GOVERNMENT OF RAJASTHAN

DIRECTORATE OF ECONOMICS AND STATISTICS

Name of local area/body issuing certificate

DEATH CERTIFICATE

(Issued under section 12/17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and rule 8/13 of the Rajasthan Registration of Births and Deaths Rules, 2000 (amended in 2025)). This is to certify that the following information has been taken from the original record of death which is the register of (local area/local body) ……………………………………………………… of Sub-district/Tehsil ………………………………………………… of District ………………………………………………. of State/Union Territory ……………………………… Address of the deceased at the time of Death Permanent address of the deceased ् ्‍ पि/Remarks (if any) ……………………………………………..

...................... ह,;

Statistics Department

NOTIFICATION

Jaipur, January 31, 2025 s.o.118 .- 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 State Government, with the approval of the Central Government, hereby makes the following rules further to amend the Rajasthan Registration of Births and Deaths Rules, 2000, namely: -

1. Short title and commencement.- (1) These rules may be called the Rajasthan Registration of Births and Deaths (Amendment) Rules, 2025.

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

2. Amendment of rule 5.- In rule 5 of the Rajasthan Registration of Births and Deaths Rules, 2000, hereinafter referred to as the said rules,-

(i) the existing sub-rule (1) shall be substituted by the following, namely:- "(1) The information required to be given to the Registrar under section 8 or section 9, as the case may be, shall be in Form No. 1, 1-A, 2 and 3 for the Registration of a birth, birth of an adopted child, death and still birth respectively, hereinafter to be collectively called the reporting forms. Information if given orally shall be entered by the Registrar in the appropriate reporting forms and the signature/thumb impression of the informant obtained."; and

(ii) after the existing sub-rule (3), the following new sub-rule (4), (5) and (6) shall be added, namely:- “(4) Name, wherever it occurs in Forms 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 shall be provided in the format of DD-MM- YYYY, where DD is the date in 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 shall contain the House number, Locality, Ward number (in case of town and if available), Town or Village, Sub-district/Tehsil, District, State and PIN Code.”.

3.Amendment of rule 7.- In rule 7 of the said rules,-

(a) in title, for the existing expression “under section 10(3)”, the expression “under sub- section (2) and (3) of section 10” shall be substituted;

(b) for the existing expression “The certificate as to the cause of death”, the expression “The certificate as to the cause of death including the history of illness, if any,” shall be substituted;

(c) for the existing expression “under sub-section (3) of section 10”, the expression “under sub-sections (2) and (3) of section 10” shall be substituted; and

(d) for the existing expression “Form No. 4 or 4A as the case may be”, the expression “Form No. 4 and 4A respectively” shall be substituted.

4. Amendment of rule 8.- In rule 8 of the said rules,-

(a) in title, for the existing expression “Extracts of registration entries to be given under section 12”, the expression “Certificate of registration of births or deaths to be given under section 12” shall be substituted;

(b) in the sub-rule (1),-

(i) for the existing expression “The extracts of particulars”, the expression “The certificate of birth or death extracted” shall be substituted; and

(ii) for the existing expression “given to an informant”, the expression “given to an informant, electronically or otherwise,” shall be substituted;

(c) the existing sub-rule (2) shall be substituted by the following, 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 in the house, 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) for the existing expression “shall transmit the extracts”, the expression “shall transmit the certificate, electronically or otherwise,” shall be substituted; and

(ii) for the existing expression “the nearest relative of the head present in the house”, the expression “the nearest relative of the head present in the house or, in his absence the oldest adult person present in the house” shall be substituted;

(e) in sub-rule (4),-

(i) for the existing expression “births and deaths referred to in clause (b) to (e)”, the expression “births and deaths, as the case may be, referred to in clauses (b) to (e) including clause (da), (db) and (dc)” shall be substituted;

(ii) for the existing expression “collect the extract”, the expression “obtain the certificate electronically or otherwise” shall be substituted; and

(f) in sub-rule (5), for the existing expression “extract”, the expression “certificate” shall be substituted.

5. Amendment of rule 9.- In rule 9 of the said rules, -

(a) in sub-rule (i), for the existing expression “rupee one”, the expression “twenty rupees” shall be substituted; and

(b) the existing sub-rule (ii) and (iii) shall be substituted by the following, namely: - “(ii) Any birth or death of which delayed information is given to the Registrar after thirty days but within one year or its occurrence, shall be registered only with the written permission of the District Registrar or the Block Statistical Officer or any other officer authorized by the Chief Registrar (Births and Deaths) in this behalf and on payment of a late fee of fifty rupees and on production of self-attested document, electronically or otherwise, in Form No. 14.

(iii) 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 the District Magistrate or Sub-Divisional Magistrate or by Executive Magistrate authorized by the District Magistrate, having jurisdiction over the area where the birth or death had taken place and on payment of a late fee of one hundred rupees”.

6. Amendment of rule 12.- In rule 12 of the said rules, for the existing expression “Forms

No. 1”, the expression “Forms No. 1, 1A” shall be substituted.

7. Amendment of rule 13.- In rule 13 of the said rules, -

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

(i) for the existing expression “an extract”, the expression “a certificate of birth or death” shall be substituted;

(ii) for the existing expression “issued under section 17 shall be as follow”, the expression “issued electronically or otherwise under section 17 shall be as follows” shall be substituted;

(iii) for the existing expression “Rs. 2.00”, wherever occurring, the expression “Rs. 20.00” shall be substituted;

(iv) in clause (c), -

(i) for the existing expression “extract”, the expression “certificate” shall be substituted; and

(ii) for the existing expression “Rs. 5.00”, the expression “Rs. 50.00” shall be substituted;

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

(c) in sub-rule (4), for the existing expression “extracts”, the expression “certificate” shall be substituted.

8. Amendment of rule 16.- The existing sub-rule (2) of rule 16 of the said rules shall be substituted by the following, namely: - “(2) Any such offence may be compounded on payment of such sum, not exceeding two hundred and fifty rupees for offences under sub-section (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. Insertion of new rule 16A.- After the existing rule 16 and before the existing rule 17 of the said rules, the following new rule 16A shall be inserted, namely: - “16A. Appeal.- An appeal under sub-section (1) of section 25A shall be preferred in Form No. 15.”

10. Amendment of rule 17.- In rule 17 of the said rules, -

(a) in sub-rule (2), for the existing expression “court orders and the orders of the specified authorities granting permission for delayed registration received under section 13 by the Registrar”, the expression “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; and

(b) in sub-rule (3), for the existing expression “sub-section (3)”, the expression “sub-section (2) and (3)” shall be substituted.

11. Substitution of Form No. 1.- The existing Form No. 1 appended to the said rules shall be substituted by the following, namely: - ” 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

1. Date of Birth:

2. Sex (Enter "Male” or “Female” or “Transgender person”):

3. Child’s Details (if not named, leave blank): -

(a) Name, if any:

(b) Adhaar No.

(if available)

4. Father’s Details: -

(a) Name

(b) Aadhaar No. (if available)

(c) Mobile No:

First Name Middle Name Last Name First Name Middle Name Last Name

5. Mother’s Details:

(a) Name:

(b) Aadhaar No. (if available)

(c) Jan Aadhaar family identity No. (if available):

(d) Mobile No:

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/Tehsil: 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/Tehsil: 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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

9. Informant’s Details:

(a) Name

(b) Aadhaar No.

(if available)

(c) Mobile No:

(e) Address: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

Statistical Information

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/Tehsil: District:

State or Union Territory: PIN Code:

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

(a) Religion of Father:

(b) Religion of Mother:

12. Father's level of education:

13. Mother's level of education:

14. Father's Occupation:

15. Mother's Occupation:

16. 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):

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

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):

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

3. Doctor, Nurse or Trained Midwife

4. Traditional Birth Attendant

5. Relatives or others

20. Method of Delivery (Tick the appropriate entry below):

First Name Middle Name Last Name First Name Middle Name Last Name

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 below left.) 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:

Signature or left thumb mark of the informant To be filled by the Registrar Registration No:

Registration Date:

Registration Unit:

Date of Birth:

Sex: - Male/ Female / Transgender person Place of Birth: 1. Hospital / Institution 2. House 3. Other place Remarks (if any):

Name and Signature of the Registrar" Instructions for completing the Form 1: BIRTH REPORT Name Code No.

District Item No. Instructions 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 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,9 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]. If child is not named, leave blank. Birth can be registered without name of the child. However, name of child can be inserted, free of charge, within 12 months of registration (Refer Rule10 of State Rules). 6,7,8,9 Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub-district/ Tehsil, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.

8 Tick the appropriate entry for place of birth

2. House

3. Other place Give the name and address of the “Hospital/Institution” or the address of the “House” or ‘Other place” where the birth took place.

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

12. Insertion of new Form No. 1A.- After the Form No. 1, so substituted and before the existing Form No. 2 appended to the said rules, the following new Form No. 1A shall be inserted, namely: - "Form NO.1-A (Legal information) (see rule 5) [ SEE REVERSE FOR INSTRUCTIONS]

BIRTH REPORT FOR ADOPTED CHILD

This part to be added to the Birth Register To be filled by the informant 1*. Date of Birth:

2*. Sex (Enter "Male” or “Female” or “Transgender person”):

3. Child’s Details (if name is changed on adoption, write new name): -

(a) Name of the Child:

(b) Aadhaar No. (if available) 4*. Mother’s Details (If known): -

(a) Name:

(b) Aadhaar No. (if available) family identity No. (if available)

(d) Mobile No:

5*. Father’s Details (If known): -

(a) Name

(b) Aadhaar No (if available) 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. The house address is not required to be entered.

12,13 Level of Education–Write one of following — (Enter the completed level of education e.g. if studied up to class VII but passed only class VI, write class VI) 14,15 Occupation-Write one of following—

1. Cultivator

2. Agriculture Labourer

3. Daily Wages Earner (Other than Agriculture Labourer)

5. Employer

6. Government Employee

7. Private Employee (Other than Domestic Helper)

8. Domestic Helper First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name 1.Pre- Primary Undergraduate

21. Literate without formal education Postgraduate family identity No. (if available)

(d) Mobile No:

6. Details of adoption deed/order:

(a) Date:

(b) Number of Adoption deed/order.

7. Adoptive Mother's Details: -

(a) Name

(b) Aadhaar No (if available) family identity No. (if available)

(d) Mobile No:

8. Adoptive Father's Details:

(a) Name:

(b) Aadhaar No. (if available):

family identity No. (if available)

(d) Mobile No:

9. 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/Tehsil: District:

State or Union Territory: PIN Code:

10. Permanent address of adoptive parents: House No:

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

Town or Village: Sub-district/Tehsil: 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 Institution” or the address of the "House" or 'Other place where the birth took place):

1. Hospital / Institution 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: 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/Tehsil: District:

State or Union Territory: PIN Code:

13. Informant’s Details:

(a) Name:

(b) Aadhaar No. (If available):

(c) Mobile No:

(e) Address: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

*As contained in the original birth certificate.

Statistical Information

14. For Religion [Enter appropriate religion "Hindu" or Muslim” or “Christian” or "Sikh" or "Buddhist or “Jain” or “other (Please specify)”]

(a) Religion of Adoptive Father:

(b) Religion of Adoptive Mother:

15. Adoptive Father's level of education:

16. Adoptive Mother's level of education:

First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name

17. Adoptive Father's Occupation:

18. Adoptive Mother's Occupation:

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:

Signature or left thumb mark of the informant To be filled by the Registrar Registration No:

Registration Date:

Registration Unit:

Date of Birth:

Sex: - Male/ Female / Transgender person Place of Birth: 1. Hospital / Institution 2. House 3. Other place Remarks (if any):

Name and Signature of the Registrar" Instructions for completing the Form 1-A: BIRTH REPORT FOR ADOPTED CHILD Item No. Instructions 1,6 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.

If date of birth is unknown, record the date of birth as reflected in adoption order or deed, as the case may be.

Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries.

2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,7,8,13 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].

9,10,11,12,13 Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub- district/Tehsil, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.

15,16 Level of Education–Write one of following— (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, Name Code No.

District 1.Pre- Primary /Under graduate 21.Literate without formal education graduate /Certificate 20.Doctorate & above 17,18 Occupation-Write one of following—

1. Cultivator

2. Agriculture Labourer

3. Daily Wages Earner (Other than Agriculture Labourer)

5. Employer

6. Government Employee

7. Private Employee (Other than Domestic Helper)

8. Domestic Helper 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 The informant must ensure that no item in the form for Birth Report for Adopted Child is left blank to the extent possible.

13. Substitution of Form No. 2 to 13.- The existing Form No. 2 to 13 appended to the said rules shall be substituted by the following, namely: - “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

2. Deceased’s Details: -

(a) Name:

(b) Aadhaar No. (if available):

(c) Date of Birth (if available):

(d) Age:

3. Sex (Enter “Male” or “Female” or “Transgender person”):

4. Mother’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Mobile No:

5. Father’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Mobile No:

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No.

(if available):

(d) Date of Birth (if available):

(e) Age :( in completed years):

(f) Mobile No:

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/Tehsil: District:

First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name 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/Tehsil: 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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

10. Informant’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No.

(if available)

(d) Mobile No:

(f) Address: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

Statistical Information 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/Tehsil:

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)”):

13. Occupation of the deceased:

14. Type of Medical Attention received before death (Tick the appropriate entry below):

1. Institutional

2. Medical attention other than Institution

3. No Medical attention

15. Was the cause of death medically certified? (Tick the appropriate entry below):

1. Yes 2. No

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

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):

1. Yes 2. No

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 form (including pan masala) – for how many years?

21. If used to habitually drink alcohol – for how many years? First Name Middle Name Last Name 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:

Signature or left thumb mark of the informant To be filled by the Registrar Registration No:

Registration Date:

Registration Unit:

Date of Death:

Sex: - Male/ Female / Transgender person Age of deceased:

Place of Death: 1. Hospital / Institution 2. House 3. Other place Remarks (if any):

Cause of death (as per Form 4/4A) Name and signature of the Registrar Instructions for completing the Form 2: DEATH REPORT Item No. Instructions 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.

2,4,5,6,10 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 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 2(d) 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.

7,8,9,10 Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub- District/Tehsil, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.

9 For Place of death tick the appropriate entry

2. House

3. Other place Give the name and address of the “Hospital/Institution” or the address of the “House” or ‘Other place” where the death took place.

11 Town or Village of the Residence of the deceased: Place where the deceased usually lived. This can be different from the place where the death occurred. The house address is not required to be entered.

Name Code No.

District 13 Occupation- Write one of following—

1. Cultivator

2. Agriculture Labourer

3. Daily Wages Earner (Other than Agriculture Labourer)

5. Employer

6. Government Employee

7. Private Employee (Other than Domestic Helper)

8. Domestic Helper 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

1. Date of Birth:

2. Sex (Enter “Male” or “Female” or “Transgender person”):

3. Father’s Details: -

(a) Name

(b) Aadhaar No. (If available):

(c) Mobile No

4. Mother’s details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No.

(if available):

(d) Mobile No:

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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

6 . Informant’s Details:

(a) Name:

(b) Aadhaar No. (if available):

(c) Mobile No:

(e) Address: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

Statistical Information

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/Tehsil: District:

State or Union Territory: PIN Code First Name Middle Name Last Name Name First name Middle Name Last Name First Name Middle Name Last Name

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

9. Mother’s level of education:

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

3. Doctor, Nurse or Trained Midwife

4. Traditional Birth Attendant

5. Relatives or others

11. Duration of pregnancy (in weeks):

12. Cause of foetal death (if known):

(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.) 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 Birth and Deaths Act, 1969 (amended in 2023) for submitting false information. Also, I give consent, under the 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:

Signature or left thumb mark of the informant To be filled by the Registrar Registration No:

Registration Date:

Registration Unit:

Date of Birth:

Sex: - Male/ Female / Transgender person Place of Birth: 1. Hospital / Institution 2. House 3. Other place Remarks (if any):

Name and signature of the Registrar Instructions for completing the Form 3: STILL BIRTH REPORT Item No.

Instructions 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 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,6 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]. 5,6 Address, wherever it occurs, shall contain the name of State or Union Territory, District, Sub- district/Tehsil, Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.

Name Code No.

District 5 For Place of birth tick the appropriate entry

2. House

3. Other place Give the name and address of the “Hospital/Institution” or the address of the “House” or ‘Other place” where the birth took place.

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.

9 Level of Education–Write one of following— (Enter the completed level of education e.g. if studied up to class VII but passed only class VI, write class VI)

12. Cause of foetal death–Write one of following— 1.Bleeding (Hamorrhage) 7.Diabetes in the mother 13.Infection in the mother Parvovirus B19 2.Problems with Placental 8.Infection in the mother Coxsackie virus 14.Infection in the mother Q fever 3.Problem with umbilical cord 9.Infection in the mother Herpes simplex 15.Infection in the mother Rubella (German measles) 4.Pre-eclampsia 10.Infection in the mother Leptospirosis 16.Infection in the mother Flu 5.Genetic physical defect in the baby 11.Infection in the mother Lyme disease 17.Infection in the mother Toxoplamosis 6.Liver disorder in the mother (obstestric cholestas) 12.Infection in the mother Malaria 18.Not stated 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 birth) 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:

1.Pre- Primary graduate 21.Literate without formal education graduate Certificate 20.Doctorate & above

SEE REVERSE FOR INSTRUCTIONS

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 below1month 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 mor bid 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”.

NAME OF DECEASED: First Name Last Name Middle Name For use of Statistical Office Sex Age at Death If 1 year or more, age in years If less than 1 year, age in month If less than one month, age in days If less than one day, age in hours

1. Male

2. Female

3. Transgender Person

CAUSE OF DEATH

I (a) ……………………………………………………...

Immediate cause due to (or as a consequences of) State the disease, injury or complication which Caused death, not the mode of dying such as heart Failure, asthenia, etc.

due to (or as a consequences of) Morbid conditions, if any, giving rise to the above Cause, stating underlying conditions last II (c) ………………….…………………………………….

Other significant conditions contributing to the death ….…………………………………………………… But not related to the disease or condition causing it ……………………………………..……………….. Interval between onset and death approx.

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 in variably 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 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 at……………………………….A.M./P.M.

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:

SEE REVERSE FOR INSTRUCTIONS

First Name NAME OF DECEASED: Middle Name Last Name For use of Statistical Office Sex Age at Death If 1 year or more, age in years If less than 1 year, age in month If less than one month, age in days If less than one day, age in hours

1. Male

2. Female

3. Transgender Person

CAUSE OF DEATH

I (a)……………………………………………………..

Immediate cause due to (or as a consequences of ) State the disease, injury or complication which Caused death, not the mode of dying such as heart Failure, asthenia, etc.

due to (or as a consequences of) Morbid conditions, if any, giving rise to the above cause, stating underlying conditions last II (c)………………….…………………………………….

Other significant conditions contributing to the death ….…………………………………………………… But not related to the disease or condition causing it ……………………………………..……………….. Interval between onset and death approx.

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 below1month 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.

Form No. -5 (see rule 8 and 13)

GOVERNMENT OF RAJASTHAN

DIRECTORATE OF ECONOMICS AND STATISTICS

Name of local area / body issuing certificate

BIRTH CERTIFICATE

(Issued under section 12/17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and

Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules, 2000 (amended in 2025)). 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/Tehsil ekrk dk uke @Name of Mother………………………………………………………………………………… ekrk dk vk/kkj u-@Aadhaar No. of Mother firk dk uke@Name of Father ------------------ firk dk vk/kkj ua-@Aadhaar No. of father Address of parents at the time of birth of child Permanent address of parents fVIi.kh@Remarks (if any) ………………………… izkf/kdkjh ds gLrk{kj@ Signature of the issuing authority izkf/kdkjh dk irk @Address of the issuing authority izR;sd tUe ,oa èR;q dk iathdj.k lqfuf’pr djssaA Ensure registration of every birth and death la- No.

Form No. -6 (see rule 8 and 13)

GOVERNMENT OF RAJASTHAN

DIRECTORATE OF ECONOMICS AND STATISTICS

Name of local area / body issuing certificate

DEATH CERTIFICATE

(Issued under section 12/17 of the Registration of Births and Deaths Act, 1969 (amended in 2023) and

Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules, 2000 (amended in 2025)). 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 /Tehsil ekrk dk vk/kkj u-/Aadhaar No. of Mother firk dk vk/kkj u-/Aadhaar No. of Father Address of the deceased at the time of Death Permanent Address of the deceased izkf/kdkjh ds gLrk{kj/ Signature of the issuing authority izkf/kdkjh dk irk@Address of the issuing authority izR;sd tUe ,oe~ e`R;q dk iathdj.k lqfuf’pr djsa@Ensure registration of every birth and death la- No.

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

1. Date of Birth:

2.Sex: (Enter “Male” or “Female” or “Transgender person”) 3.Child’s Details (if not named, leave blank): -

(a) Name, if any:

(b) Aadhaar No. (if available)

4. Father’s Details: -

(a) Name

(b) Aadhaar No. (if available)

(c) Mobile No:

5. Mother’s Details: -

(a) Name:

(b) Aadhaar No. (if available)

(c) Jan Aadhaar family identity No.(if available):

(d) Mobile No:

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/Tehsil: 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/Tehsil: 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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

9. Informant’s Details:

(a) Name:

(b) Aadhaar No. (if available)

(c) Mobile No:

(e) Address: House No:

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

Town or Village: Sub-district/Tehsil: 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 9, informant will put date and signature) Date:

Signature or left thumb mark of the informant To be filled by the Registrar Registration No.:

Registration Date:

Registration unit:

Town/ Village:

Sub- district/Tehsil:

District:

Remarks (if any):

Name and Signature of the Registrar First Name Middle Name Last Name First Name Last Name Middle Name Middle Name Last Name First Name Middle Name Last Name First Name

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

1. Date of Death

2. Deceased’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Date of Birth (If available):

(d) Age:

3. Sex (Enter “Male” or “Female” or “transgender person”):

4. Mother’s details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Mobile No:

5. Father’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Mobile No:

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No.( if available):

(d) Date of Birth (if available):

(e) Age (in completed years):

(f) Mobile No:

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/Tehsil: 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/Tehsil: District:

State or Union Territory: PIN Code:

9. Place of death (Tick the appropriate entry 1or 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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

10. Informant’s Details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No.

(if available):

(d) Mobile No:

(f) Address: House No:

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

Town or Village: Sub-district/Tehsil: 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 10, Informant will put date and signature) Date:

First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name First Name Middle Name Last Name Signature or Left thumb mark of the Informant To be filled by the Registrar Registration No:

Registration Date:

Registration Unit:

Town /Village: Sub-district/Tehsil: District:

Remarks (if any):

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

Name and signature of the Registrar

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

1. Date of Birth:

2. Sex (Enter “Male” or “Female” or “Transgender person”):

3. Father’s Details: -

(b) Aadhaar No. (If available):

(c) Mobile No (d)Email Id:

4. Mother’s details: -

(a) Name:

(b) Aadhaar No. (If available):

(c) Jan Aadhaar family identity No. (if available):

(d) Mobile No

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 2. House 3. Other place Name of Hospital/Institution: Address of 1/2/3: House No:

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

Town or Village: Sub-district/Tehsil: District:

State or Union Territory: PIN Code:

6. Informant’s Details:

(a) Name

(b) Aadhaar No. (if available)

(c) Mobile No:

(e) Address: House No:

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

Town or Village: Sub-district/Tehsil: 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 6, Informant will put date and signature) 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 First Name Middle Name Last Name Name First name Middle Name Last Name First Name Middle Name Last Name FORM No. 10 (see rule 13)

NON - AVAILABILITY CERTIFICATE

(Issued under Section 17 of the Registration of Births and 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/Tehsil) ........................................................... of (District).......................................of (State) ................................................... and found that the event relating to the birth/death of ……................................................... son/ daughter of ............................................... was not registered. Date:

Signature of issuing authority Seal FORM No. 11 (see rule 14)

SUMMARY MONTHLY REPORT OF BIRTHS

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

2. District:

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 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:

Submitted to the Chief Registrar/District Registrar Male Female Transgender Person

FORM NO.12

(see rule 14)

SUMMARY MONTHLY REPORT OF DEATHS

1. Report for the month of: ______________________Year___________________________

2. District:

4. Registration Unit:

5. Details of Deaths Registered during the month:

Deaths (Including all Infant deaths & Child Deaths & Maternal Deaths) Infant Deaths (Age Iess than one year) Child Deaths (Age one year or more but less than five years) Maternal Deaths Male Female Transgender Person Total* Male Female Transgender Person Total Male Female Transgender Person Total

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:

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. Date: Signature and Name of the Registrar Submitted to the Chief Registrar /District Registrar

FORM NO.13

(see rule 14)

SUMMARY MONTHLY REPORT OF STILL BIRTHS

1. Report for the month: ______________________Year_________________________________

2. District

4. Registration Unit:

5. Number of Still Births Registered during the month:

Male Female Transgender Person

6. Time Gap in Still 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 should be equal to the number of statistical part of Still Birth Report Forms (Form no. 3) attached with this monthly report. Date: Signature and Name of the Registrar Submitted to the chief Registrar /District Registrar”

14. Addition of new Form No. 14 and 15.- After the Form No. 13, so substituted, the following new Form No. 14 and 15 shall be added, namely: - “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)…………,

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. Date: Name and Signature or thumb mark of the informant 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 House number, Locality, Ward number (in case of town and if available), Town or Village, Sub- district/ Tehsil, District, State or Union Territory and PIN Code.

Form No. 15 (see rule 16 A)

FORM FOR APPEAL

(To be submitted to District Registrar/Chief Registrar) (under section 25A 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) State District Sub – Locality

RU ID

Name of Registrar/Distt. Registrar or any officer authorized to act as Registrar/District Registrar

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 Appellant details:

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 eg 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 House number, Locality, Ward number (in case of town and if available), Town or Village, Sub- district/Tehsil, District, State or Union Territory and PIN Code.". By order of the Governor, Anupama Jorwal, Special Secretary to the Government.

Government Central Press, Jaipur.

Name Address Aadhaar no. E-mail Id Mobile No

Provisions this notification answers to

Read out of the instrument itself: an enabling provision is one it says it was made under, which is the power it rests on. The rest it names without resting on.

Other instruments under the same Act

All of the The Registration of Births and Deaths Act, 1969