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Government of Karnataka

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Chief Registrar of Births and Deaths

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FORM No. 10
(See Rule 13)
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(1969 cww oS wup Avx, yNo 17 S Nlu)
NON-AVAILABILITY CERTIFICATE
(Issued under Section 17 of the Registration of Births & Deaths Act, 1969)

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vu (S) wup S uww wlTu q
cww/oN vu Uhw
wup N0l0v0u D N umNTu.

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
.........village/town of ----------------------------taluk ----------------------------- of
........... district of Karnataka State and found that the event relating to the
birth/death of ------------------------------------------------------------------------------------ Son/Daughter
of -----------------------------------was not registered.

vwN : yo yq Nl yvN
Date: Signature of the issuing authority

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Seal :