To,
The
Registrar
Birth
& Death,
GNCT
OF DELHI, New Delhi
Sub. : Request for issuance of
Birth Certificate.
Sir/Madam,
My wife has delivered a baby on 17-06-2012 at
2.45pm at SANJAY GANDHI MEMORIAL HOSPITAL,S-BLOCK, MANGOL PURI, NEW DELHI
and my brief particulars are as under :-
1. Name
of Mother : Smt. REENA DEVI.
2. Name
of Father : Sh. UPENDER MEHTO
3. Address : XXXX, JAWALA
PURI, NEW DELHI-110087
4. Date
of child birth : 17-06-2012 at 2.45 pm.
5. Name
of child : ……………………………………..
The
name of the baby has not yet been entered in any Municipal Corporation of Delhi
records and we have named the child “……………………” and I will not change name in
future.
I
may kindly be issued birth certificate of 05 copies as per the above
particulars.
Thanking you,
Yours
faithfully,
(Sh.
UPENDER MEHTO)
AFFIDAVIT
I, REENA DEVI W/o Sh. UPENDER
MEHTO R/o xxxxx, JAWALA PURI, NEW
DELHI-110087, Do hereby solemnly affirm and declare as under:-
1. That the deponent is the resident of the above
said address.
2.
That
I was issued my son/daughter birth
certificate No. MCDOLIR-0112005227042,
Delhi. When I verified the details, I found that the clerical/technical
mistake in the entry relating to mother, father name & address printed in
it is different from my actual details. It is a clerical mistake by the
hospital & registrar office staff. That the deponent is urging for with
correction & issue of fresh birth certificate. My brief particulars are as
under:-
S. NO
|
PARTICULARS
|
INCORRECT DETAILS
|
CORRECT DETAILS
|
1
|
Name
of Mother
|
REENA
|
REENA DEVI
|
2
|
Name
of Father
|
UPENDER
|
Sh. UPENDER MEHTO
|
3
|
Address
|
Z-173,PREM
NAGAR-II, NEW DELHI
|
xxx, JAWALA PURI,
NEW DELHI-110087 |
3. That my statement is true and correct.
DEPONENT
VERIFICATION:-
Verified that the content of
this Affidavit are true and correct to the best of my knowledge and belief and
that nothing material has been concealed there from.
DEPONENT
To,
The Medical Superintendant,
Sanjay Gandhi Memorial Hospital,
S-Block, Mangol Puri, New Delhi.
Subject: Request
for issuance of Birth Certificate.
Respected Sir,
I would like to bring to your kind notice that I had
delivered a baby on 17-06-2012 at 2.45pm at SANJAY GANDHI MEMORIAL HOSPITAL,S-BLOCK, MANGOL PURI, NEW
DELHI. I was issued my son/daughter birth certificate No.
MCDOLIR-0112005227042, Delhi. When I verified the details, I found that the
clerical/technical mistake in the entry relating to mother, father name &
address printed in it is different from my actual details. It is a clerical
mistake by the hospital & registrar office staff. That I am urging for with
correction & issue of fresh birth certificate. My correct particulars are
as under:-
S.
NO
|
PARTICULARS
|
INCORRECT
DETAILS
|
CORRECT
DETAILS
|
1
|
Name
of Mother
|
REENA
|
REENA DEVI
|
2
|
Name
of Father
|
UPENDER
|
Sh. UPENDER MEHTO
|
3
|
Address
|
Z-173,PREM NAGAR-II, NEW DELHI
|
xxxxx, JAWALA PURI,
NEW DELHI-110087 |
Therefore, I humble request to you kindly issue me
the fresh birth certificate with above correction.
Thanking
you,
With Regards,
(REENA DEVI W/o SH. UPENDER MEHTO)
xxxx, JAWALA PURI, NEW DELHI-110087
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