APPLICATION FOR THE CHILD NAME INCLUSION IN BIRTH CERTIFICATE

WITH IN ONE YEAR

FROM: To,
NAME: K. RAJA NAVEEN KUMAR, RIGISTER OF BIRTH AND DEATHS,
ADDRESS:H.No.13-3-1049/138, CIRCLE NO:5,
INDIRA NAGAR, JIYAGUDA, COMMISSINER&DIRECTOR
HYDERABAD-500006, OF MUNICIPAL ADMINISTRATION
PHONE NO:9989107940. G.H.M.C,
HYDERABAD.

Sir,

I, KINDINLA. RAJA NAVEEN KUMAR S/o./W/o. Late KINDINLA. LALAIAH, Aged

about 31 years working as Govt. Servant, as Asst. Librarian Grade-I, in the Department of

Public Libraries, Hyderabad, Residing at H.No.13-3-1049/138, INDIRA NAGAR,

JIYAGUDA, HYDERABAD-500006.

I declare that my wife Smt.KINDINLA. RAVALI was Delivered F emale C hild in GOVT.

MODERN METERNITY HOSPITAL, PETLABURJ, HYDERABAD (Place of Birth) on

22.10.2020 at 12.05 AM (Date of Birth).

 Requested for kindly go through the below details and include the child name in Birth
Registrations accordingly and provide Birth Certificate.

1) Name of the Registration unit : Registrar of Births & Deaths,

Circle No.5, G.H.M.C., Hyderabad.
2) Registration year : 2020

3) Registration No. :
22119
4) Date of Registration :
30-Nov-2020
5) Date of Birth :
22-Oct-2020
6) Name of the Mother :
Smt. KINDINLA. RAVALI
7) Name of the Father :
Sri. KINDINLA. RAJA NAVEEN KUMAR
8) Name of the child to be included :
KINDINLA. VASUMATHI
9) Sex :
FEMALE
10) Name and Address of the Applicant : K. RAJA NAVEEN KUMAR,RIGISTER
with Mobile No. and email ID OF BIRTH AND DEATHS,
H.No.13-3-1049/138,
INDIRA NAGAR,
JIYAGUDA, HYDERABAD-500006,
PHONE NO:9989107940.
11) Relationship with Child :
FATHER

Encl: 1) Application Form *

□ I hereby declare that the above-mentioned information is correct up to my knowledge and

I bear the responsibility for the correctness of the above-mentioned.
Name & address,
K. RAJA NAVEEN KUMAR,
H.No.13-3-1049/138,
INDIRA NAGAR,
JIYAGUDA, HYDERABAD-500006,
PHONE NO:9989107940

Signature & Name of the father of child Signature &Name of the mother of child

(Sri. KINDINLA. RAJA NAVEEN KUMAR) (Smt. KINDINLA. RAVALI)