IN

THE COURT OF JUDICIAL MAGISTRATE OF

FIRST CLASS AT PEN
Cri M.A /2018


Badrunnisa Mohammad Ismail khot
Age 74, Occupation Business
196-21 kaki ki chal, Applicant
kachchi mohalle, MG Road
Panvel , District Raigad,410206

Versus


Nobody Respondent




Application for Registration
of Birth and Death Act 1969
u/s 13(3)

The Applicant abovenamed submits this application, praying
to state as follows:

1. That this application is to issue necessary direction to Pen
Nagarparisad for the registration of Birth of Applicant
Nasim Usman Khot in their birth registry.

2. That the applicant Badrunnisa Mohammad Ismail khot
Daughter of Mohammad Ismail Khot is the Permanent
resident of 196-21 kaki ki chal, kachchi mohalla, MG Road
Panvel , District Raigad,410206.

3. That Applicant Submits that he i.e. Badrunnisa Mohammad
Ismail khot on 13/04/1946 (Thirteenth April Nineteen
fourtysix ) at Pen District Raigad and whose birth

 was not registered by Municipal Corporation in Birth
Registry.

4. That Applicant's father did not intimate the birth of applicant
because of ignorance of law relating to birth
registration.

5. That, since Birth of applicant is not registered within one
year of its occurrence, therefore, this application is made
before Hon’ble Court.

6. That Birth certificate of Applicant is necessary and required
for Offical and Judicial Purpose.


7. That applicant most humbly Prays that this Hon'ble Court
may be pleased to issue necessary direction to pen
Nagarparisad under the Registration of Birth and Death Act
1969 section 13(3), to register the birth of the applicant and
render justice.

Pen
Date
Applicant

VERIFICATION

I, Badrunnisa Mohammad Ismail khot, age 74 years

the applicant abovenamed, do hereby state on solemn affirmation
that the contents of paras of this application in 1 to 7 are true and
correct to the best of my knowledge and belief, and so, I have
signed hereunder.

Pen
Date
Applicant