7/26/2019 Form4 (2)

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The Consular Ofcer,Embassy o India,

Riyadh

Subject : Registration of Birth

Dear Sir,It is requested that the birth o my child whose particulars are i!en below, may "indly be

reistered in the Indian #irth Reister and a birth certi$cate issued to me% &n entry may be made in

his'her ather(s'mother(s passport )

*% +ame o child )% Date o #irth o child )-% .lace o #irth o child)/% Se0 o child ) 1ale 2 3 4emale 2 35% 4ather(s .articulars )

+ame )+ationality ).assport +o% )Date o Issue ).lace o Issue )

6% 1other(s .articulars )

+ame )+ationality ).assport +o% )Date o Issue ).lace o Issue )

The ollowin documents are attached herewith )

(a) .hotocopy o ather(s passport%

(b) 1other(s .assport in oriinal and .hotocopy%

(c) #irth certi$cate 2in oriinal3 issued by the 1inistry o 7ealth%

(d) .hotocopy o birth certi$cate and its authori8ed translation in Enlish%

(e) .hotocopy o marriae certi$cate%Date ).lace )

99999999999999999%Sinature o &pplicant

+ame99999999999999999%&ddress9999999999999999%

999%9999999999999999%Tel +o% 9999999999999999%

7/26/2019 Form4 (2)

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NO. RIY/C/BR//200 Dated :

1. Name of the child :

2. Date of Birth :

3. Place of Birth :

4. e! :

". Name of the father :

#. Name of the mother :

$. Claim of %ather/&other to I'dia' Citi(e')hi* +,: Birth/De)ce't

-. i'atre of %ather :

. i'atre of &other :

10. Perma'e't ddre)) i' :

I'dia

11. ddre)) i' : P.O. Box

Tel. No.

%OR O%%ICI 5 ONY :

6he' rei)tered : ..

I, ., of the Embassy of India at Riyadh, Kingdom of Sadi !"abia do he"eby #e"tifythat this is a t"e #o$y of the ent"y of bi"th of . ente"ed at se"ial No.R%&%'%BR%...%()) in the "egiste" of bi"ths *e$t in this Embassy.

+itness by hand and seal, this day of . ())

Signat"e of 'onsla" Offi#e"

5m+a)), of I'diaPo)t Bo! No. 43-$

Ri,adh 11#3 adi ra+ia

C5R7I%IC75 O% 5N7RY O% BIR78

O% N INDIN CI7I95N 6I78IN 785

DI7RIC7 O% 785 5&BY O%

INDI RIYD8