PART 1particulars to be entered where the record of the birth was created on or before 30th September 1973
Birth Registered in the District of
in the Superintendent Registrar’s district of
in the county of
Entry number
Date and Place of birth
Name (if any) (child’s forename(s))
Sex
Name and Surname and Dwelling-place of Father
Name and Surname and Maiden Surname of Mother
Rank or Profession of Father
Signature, Qualification and Residence of Informant
When Registered
Signature of Registrar
Baptismal Name if added after Registration of Birth and Date