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Y%S ,xld / SRI LANKA REGISTER OF BIRTHS
Wmamekak ,shdmosxÑ lsÍfï f,aLkh
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Y%S ,xld / SRI LANKA Wmamekak ,shdmosxÑ lsÍfï f,aLkh : wxlh- No. } ........
Wmamekak yd urK ,shdmosxÑ lsÍfñ wd{dmk; ^110 jk mrsÉfÊoh : Births and Deaths Regitration Act (Cap.110)
osia;%slalh District } . . . . . . . . . . . . . . . . . . . . . . . . . . . fldÜGdYh Division } . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Wmka oskh yd ia:dkh ... …
In Tamil language ???? ... …
Date and place of birth … …
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2. ku . . . . . . . . .
In Tamil language ???? ... …
Name . . . . .
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3. ia;%S mqreI Ndjh . . . . . .
In Tamil language ???? ... …
Sex . . . . . .
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4. mshdf.a
In Tamil language ?
Father's
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iïmQ¾K ku full name
In Tamil language ???? ... …
In - Other languages ......?
Wmka oskh date of birth
In Tamil language ???? ... …
In - Other languages ......?
Wmka ia:dkh place of birth
In Tamil language ???? ... …
In - Other languages ......?
cd;sh race
In Tamil language ???? ... …
In - Other languages ......?
;;a;ajh fkdfyd;a jD;a;sh
In Tamil language ???? ... …
In - Other languages ......?
Rank or profession
In Tamil language ???? ... …
In - Other languages ......?
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5. ujf.a
In Tamil language ? …
Mother's
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iïmQ¾K ku full name
In Tamil language ???? ... …
In - Other languages ......?
Wmka oskh date of birth
In Tamil language ???? ... …
In - Other languages ......?
Wmka ia:dkh place of birth
In Tamil language ???? ... …
In - Other languages ......?
cd;sh race
In Tamil language ???? ... …
In - Other languages ......?
jhi age
In Tamil language ???? ... …
In - Other languages ......?
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6. uõmshka újdylo @
In Tamil language ???? ... …
Were parents married
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7. uq;a;d Wmkafka Y%S ,xldfõ kï
In Tamil language ???? ...
If grandfather born in Sri Lanka
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Tyqf.a iïmQ¾K ku
In Tamil language ???? ... …
full name
In - Other languages ......?
Tyq Wmka j¾Ih
In Tamil language ???? ... …
his year of birth
In - Other languages ......?
Tyq Wmka ia:dkh
In Tamil language ???? ... …
his place of birth
In - Other languages ......?
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8. mshd ,xldfõ fkdbmso ó uq;a;d ,xldfõ Wmkafka kï ó uq;a;df.a
In Tamil language ???? ... …
If the father was not born in Ceylon and if great grandfather born in Ceylon, great grandfather's
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iïmQ¾K ku
In Tamil language ???? ... …
full name
In - Other languages ......?
Wmka j¾Ih
In Tamil language ???? ... …
his year of birth
In - Other languages ......?
Wmka ia:dkh
In Tamil language ???? ... …
his place of birth
In - Other languages ......?
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9. oekqï fokakdf.a iïmQ¾K ku" mosxÑ ia:dkh yd oekqï fokafka ljfrl= jYfhka o hkak
In Tamil language ???? ... …
Informant's full name, residence, and in what capacity he gives information
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10. oekqï fokakdf.a w;aik
In Tamil language ???? ... …
Informant's signature
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11. ,shdmosxÑ lrk oskh
In Tamil language ???? ... …
Date of registration
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12. f,alïf.a w;aik
In Tamil language ???? ... …
Registra's signature
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13. ,shdmosxÑ lsÍfukamiqj we;=<;a lrk ,o ke;fyd;a l,ska ;snQ ku fjkqjg w¨f;ka fhdok ,o kï
In Tamil language ???? ... …
Name inserted or substituted after registration
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14. 13 fjks wxlhg we;=<;a úia;r lreKq iemhSug wdrxÑ ÿka ;eke;a;df.a ku iy tfia oekqï ÿkafka ljfrl= jYfhka o hkak
In Tamil language ???? ... …
Name of person on whose information particulars relating to item 13 were supplied and in what capacity he give information
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15. ku we;=,;a ls Ífï fyda fjk kula fhoSfï fyda oskh yd osia;%sla f,alïf.a fyda frcsia;%d¾ ckrd,a ;ekf.a w;aik
In Tamil language ???? ... …
Date of inseration or substitution and District Registrar's or Registrar General's signature.
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I do hereby certify that the aforegoing is a true copy of the Birth Registration Entry Field of Records in this office. _ _ _ _ _ _ _ _ * I certify that the above translation is true and correct
signature of Embassy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . . . . .
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