Form No 7
Annexure-IX
Form VII
MORMUGAO MUNICIPAL COUNCIL
BIRTH REPORT
Satistical information
This part to be detached and sent for satistical processing

In the case of multiple birth, fill in a separate form for
each child and write 'Twin birth' etc., as the case may
be, in the remarks column in the box below left

To be filled by the informant
 
10. Town or Village of Residence of the mother :
(Place where the mother usually lives. This can
be different from the place where the delivery
occurred. The house address is not required to be
entered.)

a) Name of Town/Village :

b) Is it a Town or village: (Tick the appropriate entry below)

1. Town                   2. Village

c) Name of District :

d) Name of State :
 
11. Religion of the Family: (Tick the appropriate entry below)

1.  Hindu       2.  Muslim          3.  Christian

4.  Any other religion : (Write the name of the religion)
 
12. Father's level of education :
(Enter the completed level of education e.g. if studied upto class
VII but passed only class VI, write class VI)
 
13. Mother's level of education :
(Enter the completed level of education e.g. if studied upto class
VII but passed only class VI, write class V)
 
14. Father's Occupation :
(If no occupation write 'Nil')
 
15. Mother's Occupation :
(If no occupation write 'Nil')
         To be filled by the informant
 
16. Age of the mother (in completed
years) at the time of marriage :
If Married more then once, age at
first marriage may be entered)
 
17. Age of the mother (in completed
years) at the time of this of this birth :
 
18. Number of children born alive to the
mother so far including this child :
(Number of children born alive to
include also those from earlier marriage(s), if any)
 
19. Type of attention at delivery :
(Tick the appropriate entry below)

1. Institutional - Government

2. Institutional - Private or Non-Government

3. Doctor, Nurse or Trained midwife

4. Traditional Birth Attendent

5. Relatives or others
 
20. Method of Delivery:
(Tick the appropriate entry below)

1.  Natural

2.  Caesarean

3.  Forceps/Vacuum
 
21. Birth Weight (in kgs.) (if available) :
 
22. Duration of pregnancy (in weeks)
 
 

(Columns to filled are over. Now put signature at left)

To be filled by the Registrar
Name : Code No.
District :
Tehsil :
Town / Village :
Registration Unit :
Name of Father :
Name of Mother :
Registration No.:   Registration Date:
Date of Birth:
Sex:                 1. Male   2. Female
Place of Birth :1. Hospital/Institution          2. House
 


Name and Signature of the Registrar


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