The Tamil Nadu Registration of Births and Deaths Rules, 2025.

© [Regd. No. TN/CCN/467/2012-14. GOVERNMENT OF TAMIL NADU [R. Dis. No. 197/2009. 2025 [Price: Rs. 12.80 Paise. TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY PUBLISHED BY AUTHORITY No. 417] CHENNAI, THURSDAY, JULY 31, 2025 Aadi 15, Visuvaavasu, Thiruvalluvar Aandu-2056 Part III—Section 1(a) General Statutory Rules, Notifications, Orders, Regulations, etc., issued by Secretariat Departments. NOTIFICATIONS BY GOVERNMENT HEALTH AND FAMILY WELFARE DEPARTMENT THE TAMIL NADU REGISTRATION OF BIRTHS AND DEATHS RULES, 2025 [G.O.Ms. No.351, Health and Family Welfare (AB2), 31st July 2025, ஆடி 15, விசுவாாவாசு, திருவாள்ளுவார் ஆண்டு-2056.] No. SRO A-20(a)/2025. In exercise of the powers conferred by section 30 of the Registration of Births and Deaths Act, 1969, (Central Act 18 of 1969) and in the supersession of the Tamil Nadu Registration of Births and Deaths Rules, 2000, the Governor of Tamil Nadu with the approval of the Central Government hereby makes the following rules, namely:- Rules. 1. Short title, extent and commencement.- (1) These rules may be called the Tamil Nadu Registration of Births and Deaths Rules, 2025. (2) These rules shall extend to the whole of the State of Tamil Nadu. (3) They shall come into force at once. 2. Definitions.- (1) ln these rules, unless the context otherwise requires,- (a) “Act” means the Registration of Births and Deaths Act, 1969 (Central Act 18 of 1969); (b) “Form” means a Form appended to these rules; (c) “Government” means the State Government; (d) “Section” means a section of the Act; and (e) “Register” means Register of Births and Deaths. (2) Words and expressions used in these rules and not defined but defined in the Act shall have the same meaning respectively assigned to them in the Act. [ 1 ] III-1(a)—Ex. (417)2 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 3. Period of gestation.- The period of gestation for the purpose of clause (g) of sub-section (1) of section 2 shall be twenty- eight weeks. 4. Submission of report.- The report under sub-section (4) of section 4 shall be prepared in the format annexed with these Rules and shall be submitted along with the statistical report referred to in sub-section (2) of section 19 to the Government by the Chief Registrar for every year by the 31st July of the year following the year to which the report relates. 5. Giving information of births and deaths.- (1) The information required to be given to the Registrar under section 8 or section 9, as the case may be, shall be in forms. 1, 1A, 2 and 3 for the Registration of a birth, birth of an adopted child, death and still birth respectively hereinafter to be collectively called the “reporting forms”. Information, if given orally, shall be entered electronically or otherwise by the Registrar in the appropriate reporting forms and the signature or thumb impression of the informant obtained. (2) The part of the reporting forms containing legal information shall be called the “Legal Part” and the part containing statistical information shall be called the “Statistical Part”. (3) The information referred to in sub-rule (1) shall be given within Twenty one days from the date of birth, death or still birth, as the case may be. (4) Name, wherever it occurs, in the Forms in these Rules shall be provided in the format of (first name) (middle name) (last name) and name shall not contain any abbreviations. (5) Date, wherever it occurs, in the Forms in these Rules shall be provided in the format of dd-mm-yyyy where dd is the date in two digits, mm is the month in two digits and yyyy is the year in four digits. (6) The address, wherever it occurs, in the Forms in these Rules shall contain the name of the State or Union Territory, District, (Taluk, Town or Village, Ward number in case of town and if available), Locality, House number and PIN Code. 6. Birth or Death in a vehicle.- (1) ln respect of a birth or death in a moving vehicle, the person in-charge of the vehicle shall give or cause to be given the information to the Registrar under sub-section (1) of section 8 at the first place of halt. Explanation.- For the purpose of this rule, the term “Vehicle” means conveyance of any kind used on land, air or water and includes an aircraft, boat, ship, railway carriage, motor-car, motor-cycle, cart, tonga and rickshaw. (2) In the case of deaths (not falling under clauses(a) to (e) of sub-section (1) of section 8 in which an inquest is held, the officer who conducts the inquest shall give or cause to be given the information to the Registrar under sub-section (l) of section 8 of the Act. 7. Notification and Form of certificate.- (1) The certificate as to the cause of death including the history of illness, if any, required under sub-sections (2) and (3) of section 10 shall be issued by the Medical Practitioner in Form 4 and 4A respectively and the Registrar shall, after making necessary entries electronically or otherwise in the register of deaths, forward all such certificates to the Chief Registrar or the officer specified by him in this behalf by the 10th of the month immediately following the month to which the certificates relate. (2) Any person who performs the funeral ceremonies of a person dying in a local area within the jurisdiction of a municipality, panchayat or other local authority or any other area, shall whenever required furnish to the Registrar such information as he possesses regarding the particulars required for registration. 8. Certificate of registration of births or deaths.- (1) The Certificate of birth or death extracted from the register relating to births or deaths shall be given to an informant electronically or otherwise in Form 5 or Form 6, as the case may be. (2) In the case of domiciliary events of births and deaths as the case may be referred to in clauses (a), (aa), (ab) and (ac) of sub-section (1) of section 8 of the Act which are reported direct to the Registrar of Births and Deaths, the head of the house or household as the case may be, or, in his absence, the nearest relative of the head present in the house, or, in his absence, the oldest adult person present, the adoptive parents, the parent, and the biological parent, as the case may be, may obtain electronically or otherwise the certificate of birth or death from the Registrar within thirty days of its reporting. (3) In the case of domiciliary events of births and deaths referred to in clause (a) of sub-section(1) of section 8 of the Act which are reported by persons specified by the Government under sub-section(2) of the said section, the person so specified shall transmit electronically or otherwise the certificate received from the Registrar of Births and Deaths to the concerned head of the house or household as the case may be, or, in his absence, the nearest relative of the head present in the house or in his absence, the oldest adult person present, within thirty days of its issue by the Registrar.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 3 (4) In the case of institutional events of births and deaths, as the case may be, referred to in clauses (b) to (e) and (da), (db) and (dc) of sub section (l) of section 8, the nearest relative of the new born or deceased may obtain electronically or otherwise the certificate from the officer or person in-charge of the institution concerned within thirty days of the occurrence of the event of birth or death, as the case may be. (5) If the certificate of birth or death is not collected by the concerned person as referred to in sub-rules (2) to (4) within the period stipulated therein, the Registrar or the officer or person in-charge of the concerned institution as referred to in sub-rule (4) shall transmit the same to the concerned family by post within fifteen days of the expiry of the aforesaid period. 9. Authority for delayed registration and fee payable thereof.- (1) Any birth or death of which information is given to the Registrar after the expiry of the period specified in rule 5, but within thirty days of its occurrence, shall be registered on payment of a late fee of one hundred rupees. (2) Any birth or death of which delayed information is given to the Registrar after thirty days but within one year of its occurrence, shall in the case of the local authorities specified in column (1) of the Table below, be registered only with the written permission of the District Registrar or the officer specified in the corresponding entries in column (2) thereof, and on payment of a late fee of two hundred rupees and on production of self-attested document, electronically or otherwise, in Form 14. The Table. Registration Unit Type Officer (1) (2) Village Panchayat Tahsildar Town Panchayat Executive Officer Cantonment Executive Officer Municipality Commissioner Corporation Commissioner Government Medical Institution Location of Institution Village Panchayat Tahsildar Town Panchayat Executive Officer Municipality Commissioner Corporation Commissioner Neyveli Liqnite Corporation Chief Health Officer Project Area Tahsildar/ Commissioner (3) Any birth or death of which delayed information is given to the Registrar after one year of its occurrence, shall be registered only on an order made by a District Magistrate or Sub-Divisional Magistrate or by an Executive Magistrate authorized by the District Magistrate, having jurisdiction over the area where the birth or death has taken place and on payment of a late fee of five hundred rupees. (4) Any person aggrieved by any order made under sub-rules (2) and (3) by the officers specified in column (1) of the Table below may, within one month from the date of receipt of such order, prefer an appeal against such order to the authorities specified in the corresponding entries in column (2) thereof: The Table. Local Authority Officer (1) (2) Tahsildar Revenue Divisional Officer Executive Officer Revenue Divisional Officer District Revenue Officer (District Birth and Death Registrar) Executive Officer, Cantonment District Revenue Officer (District Birth and Death Registrar) Commissioner of Municipality District Revenue Officer (District Birth and Death Registrar)4 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Local Authority Officer (1) (2) District Revenue Officer (District Birth Chief Registrar of Births and Deaths and Death Registrar) / Commissioner of Corporation Chief Registrar of Births and Deaths Government Provided that the appellate authority may in its discretion allow further time not exceeding one month for preferring any such appeal, if it is satisfied that the appellant has sufficient cause for not preferring the appeal in time. 10. Period for the purpose of section 14.- (1) Where the birth of any child had been registered without a name, the parent or guardian of such child shall, within 12 months from the date of registration of the birth of child, give information regarding the name of the child to the Registrar either orally or in writing: Provided that if the information is given after the aforesaid period of 12 months but within a period of 15 years, the Registrar shall,- (a) if the register is in his possession, forthwith enter the name in the relevant column of the concerned Form in the birth register on payment of a late fee of two hundred rupees. (b) if the register is not in his possession and if the information is given orally, make a report, giving necessary particulars, and, if the information is given in writing, forward the same in the case of the Registration units specified in column (1) of the Table below to the officer specified in the corresponding entries in column (2) thereof for making necessary entry on payment of a late fee of two hundred rupees. The Table. Registration Unit Type Officer (1) (2) Village Panchayat Tahsildar Town Panchayat Executive Officer Cantonment Executive Officer Municipality Commissioner Corporation Commissioner Government Medical Institution Location of Institution Village Panchayat Tahsildar Town Panchayat Executive Officer Municipality Commissioner Corporation Commissioner Neyveli Lignite Corporation Chief Health Officer Project Area Tahsildar/ Commissioner (2) The parent or the guardian, as the case may be, shall also present to the Registrar the copy of the certificate given to him under section 12 or a certified extract issued to him under section 17 and on such presentation the Registrar shall make the necessary endorsement relating to the name of the child or take action as laid down in clause (b) of the proviso to sub-rule (1). 11. Correction or cancellation of entry in the register of births and deaths.- (1) lf it is reported to the Registrar that a clerical or formal error has been made in the register or if such error is otherwise noticed by him and if the register is in his possession, the Registrar shall enquire into the matter and if he is satisfied that any such error has occurred, he shall correct the error (by correcting or cancelling the entry) as provided in section 15 and shall in the case of local authorities specified in column (1) of the Table below send an extract of the entry showing the error and how it has been corrected to the officer specified in Column (2) of the Table below:-TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 5 The Table. Registration Unit Type Officer (1) (2) Village Panchayat Tahsildar Town Panchayat Executive Officer Cantonment Executive Officer Municipality Commissioner Corporation Commissioner Government Medical Institution Location of Institution Village Panchayat Tahsildar Town Panchayat Executive Officer Municipality Commissioner Corporation Commissioner Neyveli Lignite Corporation Chief Health Officer Project Area Tahsildar/ Commissioner (2) In the case of any error as referred to in sub rule (1) and if the register is not in his possession, the Registrar shall make a report to the officer specified in Column (2) of the Table under sub rule (1) and call for the relevant register and after enquiring into the matter, if he is satisfied that any such error has occurred he shall make necessary correction. (3) Any such correction as mentioned in sub-rule (2) shall be countersigned by the officer specified in Column (2) of the Table under sub-rule (1) in this behalf when the register is received from the Registrar. (4) If any person asserts that any entry in the register of births and deaths is erroneous in substance, the Registrar may correct the entry in the manner prescribed under section 15 upon production by that person a declaration setting forth the nature of the error and true facts of the case made by two credible persons having knowledge of the facts of the case. (5) Notwithstanding anything contained in sub-rule (1) and sub-rule (4) the Registrar shall make report of any correction of the kind referred to therein giving necessary details to the officer specified in the Table under sub-rule (1). (6) If it is proved to the satisfaction of the Registrar that any entry in the register of births and deaths has been fraudulently or improperly made, he shall make a report by giving necessary details to the officer authorized by the Chief Registrar by general or special order in this behalf under section 25 and on hearing from him take necessary action in the matter. (7) In every case in which an entry is corrected or cancelled under this rule, intimation thereof should be sent to the permanent address of the person who has given information under section 8 or section 9. 12. Form of register under section 16.- (1) The legal part of the Form 1, IA, 2 and 3 shall constitute the birth register, death register and still birth register (Form 7, 8 and 9) respectively. (2) From 1st January of each calendar year new registration number starting from 1 should be followed and it continues till 31st December of that year. (3) An event which occurred in any previous year reported during the current year shall be recorded in the current year register only. (4) A control register in Form 15 shall be maintained by the Tahsildar to watch receipt of returns from all registration units in the area and dispatch of the same to the Chief Registrar or to the officer specified by him in this behalf. 13. Fees and postal charges payable under section 17.- (1) The fees payable for a search to be made, a certificate of birth or death or a non availability certificate to be issued under section 17, electronically or otherwise shall be as follow:6 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Rupees (a) Search for a single entry in the first year for which the search is made 100.00 (b) for every additional year for which the search is continued 100.00 (c) for granting certificate relating to each birth or death 200.00 (d) For every additional copies of certificate 200.00 (e) for granting non-availability certificate 100.00 (2) Any such certificate on the basis of extract from the register relating to birth or death shall be issued under section 17 by the Registrar or the officer authorized by the Government, in this behalf in Form 5 or, in Form 6 as the case may be, and shall be certified in the manner provided in section 75 of the Bharatiya Sakshya Adhiniyam, 2023 (Central Act 47 of 2023) in the case of local authorities specified in column (1) of the Table below by the Registrar or the Officers specified in the corresponding entries in column (2) thereof. The Table. Local Authority Officer (1) (2) Village Panchayat Tahsildar (till the expiry of two years after the close of the calendar year to which the register relates) Town Panchayat Executive Officer (till the expiry of two years after the close of the calendar year to which the register relates) Cantonment area Executive Officer Municipality Commissioner Neyveli Lignite Corporation Chief Health Officer Corporation Commissioner (3) If any particular event of birth or death is not found registered, the Registrar or the officers specified in column (2) of the Table under sub rule (2) shall issue a Non-availability certificate in Form 10. (4) Any such certificate or non-availability certificate may be furnished to the person asking for it or sent to him by post on payment of the postal charges therefor. 14. Interval and forms of periodical returns under sub-section (1) of section 19.- (1) Every Registrar shall after completing the process of registration send all the Statistical Parts of the reporting forms relating to each month along with a Summary Monthly Report in Form 11 for births, Form 12 for deaths and Form 13 for still births to the Chief Registrar or the officer specified by him in this behalf on or before the 5 of the following month. (2) The officer so specified shall forward all such statistical parts of the reporting forms received by him to the Chief Registrar or the officer specified by him, not later than the 10th of that month. 15. Statistical report under section 19(2).- The statistical report under sub-section (2) of section 19 shall contain the Tables in the prescribed formats appended to these rules and shall be compiled for each year before the 31st July of the year immediately following and shall be published as soon as may be thereafter but in any case not later than five months from that date. 16. Conditions for compounding offences under section 24.- (1) Any offence punishable under section 23 may, either before or after the institution of criminal proceedings under this Act, be compounded by an officer authorized by the Chief Registrar by a general or special order in this behalf, if the officer so authorized is satisfied that the offence was committed through inadvertence or oversight or for the first time. (2) Any such offence may be compounded on payment of such sum, not exceeding two hundred and fifty rupees for offences under subsections (1), (2) and (4) of section 23 and fifty rupees for offences under sub-section (3) of section 23 and one thousand rupees in respect of each birth or death for offences under sub-sections (IA) and (4A) of section 23, as the said officer may think fit. 17. Appeal.- Any person aggrieved by any order of the authority, a appeal under sub- section (1) of section 25- A shall be in Form 16. 18. Registers and other records under section 30(2)(k).- (1) The birth register, death register and still birth register shall be records of permanent importance and shall not be destroyed.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 7 (2) The permission granted under sub-section (2) of section 13 and orders issued under sub-section (3) of section 13 for delayed registration received by the Registrar shall form an integral part of the birth register, death register and still birth register and shall not be destroyed. (3) The certificate as to the cause of death furnished under sub-sections (2) and (3) of section 10 shall be retained for a period of at least 5 years by the Chief Registrar or the officer specified by him in this behalf. (4) Every birth register, death register and still birth register shall be retained by the Registrar in his office for a period of twelve months after the end of the calendar year (Previous year and current year) to which it relates and such register shall thereafter in the case of local authorities specified in column (l) of Table below be transferred for safe custody to the officers specified in corresponding entries in column (2) thereof: The Table. Local authority Officers authorized (1) (2) Village Panchayat Tahsildar (till the expiry of two years and after the close of the calendar year to which the register relates) Village Panchayat Sub-Registrar of Assurance (after the expiry of two years) Town Panchayat Executive Officer (till the expiry of two years and after the close of the calendar year to which the register relates) Town Panchayat Sub-Registrar of Assurance (after the expiry of two years) Cantonment area Executive Officer Municipality Commissioner Neyveli Lignite Chief Health Officer Corporation Corporation Commissioner 19. Manner of payment of fees.- All fees payable under the Act shall be paid in cash or money order or postal order or through electronic mode. P. SENTHILKUMAR, Principal Secretary to Government.8 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM.1 FORM 1 (See rule 5) (See rule 5) BIRTH REPORT BIRTH REPORT Legal information Statistical information [SEE REVERSE FOR INSTRUCTIONS] [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Birth Register This part to be detached and sent for statistical processing To be filled by the informant To be filled by the informant 1. Date of Birth : D D - M M - Y Y Y Y 10. Town or Village of Residence of the mother (Place where the mother usually lives. This can be different 2. Sex (Enter “Male” or “Female” or “Transgender person”) : from the place where the delivery occurred. Tick appropriate entry “Town” or “Village” and write its 3. Child’s Details (If not named, leave blank) :- name): (a) Name, if any : First Name Middle Name Last Name Town or Village: Taluk: (b) Aadhaar No, if available: District: State : PIN Code: 4. Father’s Details:- (a) Name: First Name Middle Name Last Name 11. For Religion [Enter appropriate religion “Hindu” or (b) Muslim” or “Christian” or “Sikh” or “Buddhist” or “Jain” or Aadhaar No., if available: (c) “Other (Please specify)”] Mobile No: (a) Religion of Father: (d) Email Id: (b) Religion of Mother: 5. Mother’s Details:- (a) Name: First Name Middle Name Last Name 12. Father’s level of education: (b) Aadhaar No., if available: 13. Mother’s level of education: (c) Mobile No: (d) Email Id: 14. Father’s Occupation: 6. Address of parents at the time of Birth of the Child: House No: 15. Mother’s Occupation: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: 16. Age of the mother (in completed years) at the time State: PIN Code: of marriage (If married more than once, age at first marriage is to be written): 7. Permanent address of parents: House No: Locality: Ward number (in case of town and if available): 17. Age of the mother (in completed years) at the time Town or Village: Taluk : District: of this birth : State: PIN Code: 18. Number of children born alive to the mother so far 8. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of including this child (Number of children born alive to the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took include also those from earlier marriage(s), if any) : place) : 1.Hospital / Institution Name : 19. Type of attention at delivery (Tick the appropriate 2. House 3. Other place Address : House No: entry below): Locality: Ward number (in case of town and if available): 1. Institutional-Government Town or Village: Taluk : District: 2. Institutional – Private or Non-Government State: PIN Code: 3. Doctor, Nurse or Trained Midwife 4. Traditional Birth Attendant 9. Informant’s Details: 5. Relatives or others (a) Name: First Name Middle Name Last Name 20. Method of Delivery (Tick the appropriate entry below): (b) Aadhaar No., if available: 1. Natural (c) 2. Caesarean (d) Mobile No: 3. Forceps/Vacuum Email Id: (e) Address : House No: 21. Birth Weight (in kgs.) (if available) : Locality: Ward number (in case of town and if available): Town or Village: Taluk : District: 22. Duration of pregnancy (in weeks) : State: PIN Code: DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (In the case of multiple births, fill in a separate form (After completing all columns 1 to 22, for each child and write 'Twin birth' or 'Triple birth' informant will put date and signature) etc., as the case may be, in the remarks column in the box below left.) Date: D D - M M - Y Y Y Y Signature or (Columns to be filled are over. Now put signature at left) left thumb mark of the informant To be filled by the Registrar To be filled by the Registrar Name Code No. Registration No. : District Registration Date: D D - M M - Y Y Y Y Taluk Registration Unit : Town / Village: Town/Village : Taluk : Registration Unit : District: Registration No. : Remarks ( if any): Registration Date: D D - M M - Y Y Y Y Date of Birth : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person Place of Birth: 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar Name and Signature of the Registrar gnissecorp lacitsitats rof tnes dna dehcated eb oT Instructions for completing the FORM 1: BIRTH REPORT Item No. Instructions 1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,9 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. If child is not named, leave blank. Birth can be registered without name of the child. However, name of child can be inserted, free of charge, within 12 months of registration (Refer Rule 10 of State Rules). 6,7,8,9 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 8 Tick the appropriate entry for place of birth 1. Hospital / Institution 2. House 3. Other place Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place. 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. 12,13 Level of Education – Write one of following— 1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without Primary Undergraduate formal education 2.Class 1 7.Class 6 12.Class 11 17.PG Diploma 22.Illiterate 3.Class 2 8.Class 7 13.Class 12 18. Master / Post graduate 4.Class 3 9.Class 8 14.ITI 19.M.Phil 5.Class 4 10.Class 9 15.Diploma / 20.Doctorate & above Certificate (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write class VI) 14, 15 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant must ensure that no item in the Birth Report Form is left blank to the extent possible.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 9 Instructions for completing the FORM 1: BIRTH REPORT Item No. Instructions 1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,9 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. If child is not named, leave blank. Birth can be registered without name of the child. However, name of child can be inserted, free of charge, within 12 months of registration (Refer Rule 10 of State Rules). 6,7,8,9 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 8 Tick the appropriate entry for place of birth 1. Hospital / Institution 2. House 3. Other place Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place. 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. 12,13 Level of Education – Write one of following— 1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without Primary Undergraduate formal education 2.Class 1 7.Class 6 12.Class 11 17.PG Diploma 22.Illiterate 3.Class 2 8.Class 7 13.Class 12 18. Master / Post graduate 4.Class 3 9.Class 8 14.ITI 19.M.Phil 5.Class 4 10.Class 9 15.Diploma / 20.Doctorate & above Certificate (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write class VI) 14, 15 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant must ensure that no item in the Birth Report Form is left blank to the extent possible.10 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM .1-A FORM .1-A (See rule 5) (See rule 5) BIRTH REPORT FOR ADOPTED CHILD BIRTH REPORT FOR ADOPTED CHILD [SEE REVERSE FOR INSTRUCTIONS] [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Birth Register This part to be added to the Birth Register To be filled by the informant To be filled by the informant 1*. Date of Birth : D D - M M - Y Y Y Y 14. For Religion [Enter appropriate religion 2*. Sex (Enter “Male” or “Female” or “Transgender person”) : “Hindu” or Muslim” or “Christian” or “Sikh” or 3. Child’s details (If name is changed on adoption, write new name):- “Buddhist” or “Jain” or “Other (Please specify)”] (a) Name of the Child First Name Middle Name Last Name (b) Aadhaar No., if available: (a) Religion of Adoptive Father: 4*. Mother’s Details (If known):- (a) Name: First Name Middle Name Last Name (b) (b) Religion of Adoptive Mother: Aadhaar No., if available: (c) 15. Mobile No: Adoptive Father’s level of education: (d) Email Id: 5*. Father’s Details(If known):- 16. (a) Name: First Name Middle Name Last Name Adoptive Mother’s level of education: (b) Aadhaar No., if available: 17. (c) Mobile No: Adoptive Father’s Occupation: (d) Email Id: 6. Details of adoption deed / order:- 18. Adoptive Mother’s Occupation: (a) Date: D D - M M - Y Y Y Y (b) Number of Adoption deed / order: 7. Adoptive Mother’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 8. 1A doptive Father’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 9. Address of adoptive parents as recorded in Adoption deed / order: House No: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: 10. Permanent address of adoptive parents: House No: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: 11*. Place of birth: (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital/ Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No. Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: 12. If adoption through agency write the address of the Adoption agency: House No: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: 13. Informant’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: Email Id: (d) (e) Address : House No: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: *As contained in the original birth certificate. DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 18, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or (Columns to be filled are over. Now put signature at left) left thumb mark of the informant To be filled by the Registrar To be filled by the Registrar Registration No. : Name Code No. District Registration Date: D D - M M - Y Y Y Y Taluk: Registration Unit : Town/Village : Town / Village: Taluk: Registration Unit : Registration No. : District: Registration Date: D D - M M - Y Y Y Remarks ( if any) Date of Birth : D D - M M - Y Y Y Sex : Male / Female / Transgender person Place of Birth: 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar Name and Signature of the Registrar gnissecorp lacitsitats rof tnes dna dehcated eb oT Instructions for completing the FORM 1-A: BIRTH REPORT FOR ADOPTED CHILD This part to be detached and sent for statistical processing Item No. Instructions 1, 6 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. If date of birth is unknown, record the date of birth as reflected in adoption order or deed, as the case may be. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,7,8,13 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 9,10,11,12,13 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 15,16 Level of Education – Write one of following— 1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without Primary Undergraduate formal education 2.Class 1 7.Class 6 12.Class 11 17.PG Diploma 22.Illiterate 3.Class 2 8.Class 7 13.Class 12 18. Master / Post graduate 4.Class 3 9.Class 8 14.ITI 19.M.Phil 5.Class 4 10.Class 9 15.Diploma / 20.Doctorate & above Certificate (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write class VI) 17,18 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant responsible for reporting birth event of adopted child shall be as per the Registration of Births and Deaths Act 1969. The informant must ensure that no item in the form for Birth Report for Adopted Child is left blank to the extent possible.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 11 Instructions for completing the FORM 1-A: BIRTH REPORT FOR ADOPTED CHILD Item No. Instructions 1, 6 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. If date of birth is unknown, record the date of birth as reflected in adoption order or deed, as the case may be. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,5,7,8,13 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 9,10,11,12,13 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 15,16 Level of Education – Write one of following— 1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without Primary Undergraduate formal education 2.Class 1 7.Class 6 12.Class 11 17.PG Diploma 22.Illiterate 3.Class 2 8.Class 7 13.Class 12 18. Master / Post graduate 4.Class 3 9.Class 8 14.ITI 19.M.Phil 5.Class 4 10.Class 9 15.Diploma / 20.Doctorate & above Certificate (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write class VI) 17,18 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant responsible for reporting birth event of adopted child shall be as per the Registration of Births and Deaths Act 1969. The informant must ensure that no item in the form for Birth Report for Adopted Child is left blank to the extent possible.12 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM.2 FORM.2 (See rule 5) (See rule 5) DEATH REPORT DEATH REPORT Legal information Statistical information [SEE REVERSE FOR INSTRUCTIONS] [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Death Register To be filled by the informant To be filled by the informant 1. Date of Death D D - M M - Y Y Y Y 11. Town or village of Residence of the deceased (Place 2. Deceased’s Details:- where the deceased usually lives. This can be different (a) Name: First Name Middle Name Last Name from the place where the death occurred. Tick appropriate entry “Town” or “Village” and write its name): (b) Aadhaar No, if available: Town or Village: Taluk (Sub-district): (c) Date of Birth : D D - M M - Y Y Y Y District: State: (d) Age: PIN Code: 3. Sex (Enter “Male” or “Female” or “Transgender person”) : 12. Religion ( Enter appropriate religion “Hindu” or “Muslim” or 4. Mother’s Details:- “Christian” or “Sikh” or “Buddhist” or “Jain” or “Other (a) Name: First Name Middle Name Last Name (Please specify)”): (b) Aadhaar No, if available: 13. Occupation of the deceased: (c) Mobile No: (d) Email Id: 14. Type of Medical Attention received before death (Tick 5. Father’s Details:- the appropriate entry below): (a) Name: First Name Middle Name Last Name 1. Institutional (b) Aadhaar No., if available: 2. Medical attention other than Institution 3. No Medical attention (c) Mobile No: 15. Was the cause of death medically certified? (Tick the (d) Email Id: appropriate entry below) : 6. Spouse’s (husband / wife) Details:- 1.Yes 2. No (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: 16. N dea am the s io rrf e sD pi es ce ta ivs ee oo f r w hA ec thtu ea r l m C eda iu cs ae lly o cf e rD tife iea dth o r( nF oo tr ) :a ll (c) Date of Birth : D D - M M - Y Y Y Y (d) Age (in completed years): 17. In case this is a female death, did the death occur (e) Mobile No: while pregnant, at the time of delivery or within 6 (f) Email Id: weeks after the end of pregnancy (Tick the appropriate entry below): 7. Address of the deceased at the time of death: House No: 1.Yes 2. No Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: 18. If used to habitually smoke – State: PIN Code: for how many years? 8. Permanent address of the deceased: House No: 19. If used to habitually chew tobacco in any form – Locality: Ward number (in case of town and if available): for how many years? Town or Village: Taluk: District: State: PIN Code: 20. If used to habitually chew arecanut in any form (including pan masala) - 9. Place of death (Tick the appropriate entry 1 or 2 or 3 below and give the name and address for how many years? of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth t 1o .o Hk o sp pla itc ae l ) / : I n stitution Name : 21. I ff o u r s he od w t o m h anab y i ytu ea al rl sy ? d rink alcohol - 2. House 3. Other place Address : House No: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: 10. Informant’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: (e) Address : House No.: Locality: Ward number (in case of town and if available): Town or Village: Taluk: District: State: PIN Code: DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. To the best of my knowledge and information, the detail of Aadhaar of the deceased is not available. (After completing all columns 1 to 21, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant (Columns to be filled are over. Now put signature at left) To be filled by the Registrar To be filled by the Registrar Registration No. : Name Code No. District Registration Date: D D - M M - Y Y Y Y Registration Unit : Taluk Town/Village : Town / Village: Registration Unit : Taluk: Registration No. : District: Remarks ( if any): Registration Date: D D - M M - Y Y Y Y Cause of Death (as per Form 4 / 4A): Date of Death : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person Age of deceased: Place of death : 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar Name and Signature of the Registrar gnissecorp lacitsitats rof tnes dna dehcated eb oT Instructions for completing the FORM 2: DEATH REPORT Item No. Instructions This part to be detached and sent for statistical processing 1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2,4,5,6,10 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 3 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 2(d) If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months, and if below 1 month give age in completed number of days, and if below one day, in hours. 7,8,9,10 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 9 For Place of death tick the appropriate entry 1. Hospital / Institution 2. House 3. Other place Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the death took place. 11 Town or Village of the Residence of the deceased: Place where the deceased usually lived. This can be different from the place where the death occurred. The house address is not required to be entered. 13 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant must ensure that no item in the Death Report Form is left blank to the extent possible.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 13 Instructions for completing the FORM 2: DEATH REPORT Item No. Instructions 1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2,4,5,6,10 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 3 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 2(d) If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months, and if below 1 month give age in completed number of days, and if below one day, in hours. 7,8,9,10 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 9 For Place of death tick the appropriate entry 1. Hospital / Institution 2. House 3. Other place Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the death took place. 11 Town or Village of the Residence of the deceased: Place where the deceased usually lived. This can be different from the place where the death occurred. The house address is not required to be entered. 13 Occupation - Write one of following— 1. Cultivator 2. Agriculture Labourer 3. Daily Wages Earner(Other than Agriculture Labourer) 4. Single/Family Worker/Self Employed 5. Employer 6. Government Employee 7. Private Employee(Other than Domestic Helper) 8. Domestic Helper 9. Non-Worker Note: The informant must ensure that no item in the Death Report Form is left blank to the extent possible.14 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM .3 FORM .3 (See rule 5) (See rule 5) STILL BIRTH REPORT STILL BIRTH REPORT Legal information Statistical information [SEE REVERSE FOR INSTRUCTIONS] [SEE REVERSE FOR INSTRUCTIONS] This part to be added to the Birth Register This part to be detached and sent for statistical processing To be filled by the informant To be filled by the informant 1. Date of Birth : D D - M M - Y Y Y Y 7. Town or village of Residence of the deceased (Place where the mother usually lives. This can be different from 2. Sex (Enter “Male” or “Female” or “Transgender person”) : the place where the delivery occurred. Tick appropriate entry “Town” or “Village” and write its name): 3 (. a ) NF aa mth ee :r ’ s Details:- F irst Name Middle Name Last Name T Do isw trn ic o t:r V i l la g e : S t a t e : T a l u k: (b) Aadhaar No., if available: PIN Code: ( (dc) ) Mobile No: Email Id: 8. Age of the mother (in completed years) at the time 4. of this birth : ( (ba) ) NM ao mth ee : r ’s Details:- F irst Name Middle Name Last Name 9 . Mother’s level of education: (c) Aadhaar No., if available: (d) Mobile No: 10. Type of attention at delivery (Tick the appropriate entry 5. E Pm laa ci el Id o: f birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and below) 1: . Institutional-Government 2. Institutional – Private or Non-Government address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where 3. Doctor, Nurse or Trained Midwife the birth took place) : 4. Traditional Birth Attendant 1.Hospital / Institution Name : 5. Relatives or others 2. House 3. Other place Address : House No. Locality: 6 (. a ) NW T IS n aa t fa a ml our td rek em : : :n au nm t b ’ s e r D i ef ta a v i a l Fs i l i: a r s b t l e N : a m e T o w n o M r i d V dP i l lIl ea N g N Ce a : o m d e e : D Lis atr sic t t N: a m e 1 11 2. . D C u aura st eio on f o fof ep tr ae l g dn ea an thc y ( if ( kin n ow we ne )k :s ) : (b) Aadhaar No., if available: ( (dc) ) EM mo ab ii ll e Id N : o: (e) Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: (In the case of multiple Births, fill in a separate form for DECLA RATION: each child and write 'Twin birth' or 'Triple birth' etc., as I have furnished true information to the best of my knowledge and belief. I am aware of the the case may be, in the remarks column in the box penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting below left.) false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 12, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or (Columns to be filled are over. Now put signature at left) left thumb mark of the informant To be filled by the Registrar To be filled by the Registrar Name Code No. Registration No. : District Registration Date: D D - M M - Y Y Y Y Taluk Registration Unit : Town / Village: Town/Village : Taluk: District: Registration Unit : Remarks ( if any): Registration No. : Registration Date: D D - M M - Y Y Y Y Date of Birth : D D - M M - Y Y Y Y Sex : Male / Female / Transgender person Place of Birth: 1. Hospital/Institution 2. House 3. Other place Name and Signature of the Registrar Name and Signature of the Registrar gnissecorp lacitsitats rof tnes dna dehcated eb oTTAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 15 Instructions for completing the FORM 3: STILL BIRTH REPORT Instructions for completing the FORM 3: STILL BIRTH REPORT Item Instructions No. 1 Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2 Enter “Male” or “Female” or “Transgender Person”. Do not use abbreviation. 3,4,6 Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 5,6 Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code. 5 For Place of birth tick the appropriate entry 1. Hospital / Institution 2. House 3. Other place Give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place. 7 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. 9 Level of Education – Write one of following— 1.Pre- 6.Class 5 11.Class 10 16. Bachelor / 21. Literate without Undergraduate formal education Primary 2.Class 1 7.Class 6 12.Class 11 17. PG Diploma 22. Illiterate 3.Class 2 8.Class 7 13.Class 12 18. Master / Post graduate 4.Class 3 9.Class 8 14.ITI 19. M.Phil 5.Class 4 10.Class 9 15.Diploma / 20. Doctorate & above Certificate (Enter the completed level of education e.g. if studied upto class VII but passed only class VI, write class VI) 12. Cause of foetal death – Write one of following— 1. Bleeding (Hamorrhage) 7. Diabetes in the mother 13. Infection in the mother Parvovirus B19 2. Problems with Placental 8. Infection in the mother 14. Infection in the mother Q Coxsackie virus fever 3. Problem with umbilical cord 9. Infection in the mother 15. Infection in the mother Herpes simplex Rubella (German measles) 4. Pre-eclampsia 10. Infection in the mother 16. Infection in the mother Flu Leptospirosis 5. Genetic physical defect in 11. Infection in the mother 17. Infection in the mother the baby Lyme disease Toxoplamosis 6. Liver disorder in the mother 12. Infection in the mother 18. Not stated (obstestric cholestas) Malaria Note: The informant must ensure that no item in the Still Birth Report Form is left blank to the extent possible.16 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM. 4 MEDICAL CERTIFICATE OF CAUSE OF DEATH (See rule 7) MEDICAL CERTIFICATE OF CAUSE OF DEATH Directions for completing the form (Hospital In-patients. Not to be used for still births) To be sent to Registrar along with Form No. 2 (Death Report) Name of deceased : To be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to A copy of this certificate to be provided to the nearest relative of the deceased be written in capital letters and first name is mandatory. If deceased is an infant, not yet named at time of death, leave blank. Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age Name of the Hospital ………………………………………………………………. in months and if below 1 month give age in completed number of days, and if below one day, in hours. I hereby certify that the person whose particulars are given below died in the hospital in Ward No…………………….. Cause of Death : This part of the form should always be completed by the attending physician personally. on D D - M M - Y Y Y Y at…………………….A.M. / P.M. NAME OF DECEASED: First Name Middle Name Last Name For use of Statistical Office The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three parts, lines (a) (b) Sex Age at Death (c). If a single morbid condition completely explains the deaths, then this will be written on line (a) of Part I, and nothing more If 1 year or more, If less than 1 year, age If less than one month, If less than one day, age need be written in the rest of Part I or in Part II, for example, smallpox, lobar pneumonia, cardiac beriberi, are sufficient cause of age in years in month age in days in hours death and usually nothing more is needed. 1. Male 2. Female Often, however, a number of morbid conditions will have been present at death, and the doctor must then complete 3. Transgender person the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, respiratory failure, etc. These terms should not be CAUSE OF DEATH Interval between onset appear on the certificate at all since they are modes of dying and not causes of death. Next consider whether the immediate and death approx. cause is a complication or delayed result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes I (a) …………………………………….. there will be three stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be Immediate cause due to (or as a consequences of) State the disease, injury or complication which tabulated is always written in last in Part I. caused death, not the mode of dying such as heart failure, asthenia, etc. Morbid conditions or injuries may be present which were not directly related to the train of events causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult to decide, especially for infant deaths, Antecedent cause (b) …………………………………….. which of several independent conditions was the primary cause of death; but only one cause can be tabulated, so the doctor due to (or as a consequences of) must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II. Morbid conditions, if any, giving rise to the above cause, stating underlying conditions last Do not write two or more conditions on a single line. Please write the names of the diseases (in full) in the certificates as legibly as possible to avoid the risk of their being misread. (c) …………………………………….. II Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., “from Other significant conditions contributing to the death ….…………………………………….. but not related to the disease or condition causing it birth” “several years”. ….…………………………………….. Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause Manner of Death How did the injury occur? in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home. 1. Natural 2. Accident 3. Suicide 4. Homicide Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for all women of child- 5. Pending investigation bearing age, even though the pregnancy may have had nothing to do with the death. Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is known. If old age If deceased was a female, was pregnancy the death associated with? 1. Yes 2. No was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age. If yes, was there a delivery? 1. Yes 2. No Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified. Name and signature of the Medical Attendant certifying the cause of death Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on Date of verification : D D - M M - Y Y Y Y pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus – Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. SEE REVERSE FOR INSTRUCTIONS Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected. Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom. Manner of Death : Deaths not due to external cause should be identified as ‘Natural’. If the cause of death is known, but it is not known whether it was the result of an accident, suicide or homicide and is subject to further investigation, the cause of death should invariably be filled in and the manner of death should be shown as ‘Pending investigation’. In accordance with the provisions of section 10(2) of the Registration of Births and Deaths Act, 1969, a certificate of cause of death shall be given to the Registrar and a copy of the same to the nearest relative of the deceased.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 17 MEDICAL CERTIFICATE OF CAUSE OF DEATH Directions for completing the form Name of deceased : To be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. If deceased is an infant, not yet named at time of death, leave blank. Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months and if below 1 month give age in completed number of days, and if below one day, in hours. Cause of Death : This part of the form should always be completed by the attending physician personally. The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three parts, lines (a) (b) (c). If a single morbid condition completely explains the deaths, then this will be written on line (a) of Part I, and nothing more need be written in the rest of Part I or in Part II, for example, smallpox, lobar pneumonia, cardiac beriberi, are sufficient cause of death and usually nothing more is needed. Often, however, a number of morbid conditions will have been present at death, and the doctor must then complete the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, respiratory failure, etc. These terms should not be appear on the certificate at all since they are modes of dying and not causes of death. Next consider whether the immediate cause is a complication or delayed result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes there will be three stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be tabulated is always written in last in Part I. Morbid conditions or injuries may be present which were not directly related to the train of events causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult to decide, especially for infant deaths, which of several independent conditions was the primary cause of death; but only one cause can be tabulated, so the doctor must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II. Do not write two or more conditions on a single line. Please write the names of the diseases (in full) in the certificates as legibly as possible to avoid the risk of their being misread. Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., “from birth” “several years”. Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home. Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for all women of child- bearing age, even though the pregnancy may have had nothing to do with the death. Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is known. If old age was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age. Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified. Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus – Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected. Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom. Manner of Death : Deaths not due to external cause should be identified as ‘Natural’. If the cause of death is known, but it is not known whether it was the result of an accident, suicide or homicide and is subject to further investigation, the cause of death should invariably be filled in and the manner of death should be shown as ‘Pending investigation’. In accordance with the provisions of section 10(2) of the Registration of Births and Deaths Act, 1969, a certificate of cause of death shall be given to the Registrar and a copy of the same to the nearest relative of the deceased.18 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM 4A MEDICAL CERTIFICATE OF CAUSE OF DEATH (See rule 7) MEDICAL CERTIFICATE OF CAUSE OF DEATH Directions for completing the form (For non-institutional deaths. Not to be used for still births) (To be given to the person required under the Registration of Births and Deaths Act, 1969 to give information concerning the death to Registrar along with Form No. 2 (Death Report) Name of deceased: To be provided in the following format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. If deceased is an infant, not yet named at time of death, leave blank. I hereby certify that the deceased Shri/Smt./Km……………………………………………………..Son /Wife/ Daughter of Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year ………………………………resident of ……………………………………….. was under my treatment from ……………………… to of age, give age in months and if below 1 month give age in completed number of days, and if below one day, ………………………. and he/she died in hours. on D D - M M - Y Y Y Y at…………………….A.M. / P.M. Cause of Death : This part of the form should always be completed by the attending physician personally. NAME OF DECEASED: First Name Middle Name Last Name The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three Age at Death For use of Statistical Office parts, lines (a) (b) (c). If a single morbid condition completely explains the deaths, then this will be written on Sex If 1 year or more, If less than 1 year, age If less than one month, If less than one day, age line (a) of Part I, and nothing more need be written in the rest of Part I or in Part II, for example, smallpox, age in years in month age in days in hours 1. Male lobar pneumonia, cardiac beriberi, are sufficient cause of death and usually nothing more is needed. 2. Female 3. Transgender Often, however, a number of morbid conditions will have been present at death, and the doctor must Person then complete the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, CAUSE OF DEATH Interval between onset respiratory failure, etc. These terms should not be appear on the certificate at all since they are modes of and death approx. I (a) …………………………………….. dying and not causes of death. Next consider whether the immediate cause is a complication or delayed Immediate cause due to (or as a consequences of) result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes there will be three State the disease, injury or complication which stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be caused death, not the mode of dying such as heart tabulated is always written in last in Part I. failure, asthenia, etc. Morbid conditions or injuries may be present which were not directly related to the train of events Antecedent cause (b) …………………………………….. due to (or as a consequences of) causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult Morbid conditions, if any, giving rise to the above to decide, especially for infant deaths, which of several independent conditions was the primary cause of cause, stating underlying conditions last death; but only one cause can be tabulated, so the doctor must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II. (c) …………………………………….. II Do not write two or more conditions on a single line. Please write the names of the diseases (in full) Other significant conditions contributing to the death ….…………………………………….. in the certificates as legibly as possible to avoid the risk of their being misread. but not related to the disease or condition causing it ….…………………………………….. Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., “from birth” “several years”. If deceased was a female, was pregnancy the death associated with? 1. Yes 2. No Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be If yes, was there a delivery? 1. Yes 2. No stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home. Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for Name and signature of the Medical Practitioner certifying the cause of death all women of child-bearing age, even though the pregnancy may have had nothing to do with the death. Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is Date of verification : D D - M M - Y Y Y Y known. If old age was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age. SEE REVERSE FOR INSTRUCTIONS Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified. Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus– Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected. Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom. In accordance with the provisions of section 10(3) of the Registration of Births and Deaths Act, 1969, a certificate of cause of death shall be given to the person required under this Act to give information concerning the death.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 19 MEDICAL CERTIFICATE OF CAUSE OF DEATH Directions for completing the form Name of deceased: To be provided in the following format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. If deceased is an infant, not yet named at time of death, leave blank. Age : If the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months and if below 1 month give age in completed number of days, and if below one day, in hours. Cause of Death : This part of the form should always be completed by the attending physician personally. The certificate of cause of death is divided into two parts, I and II. Part I is again divided into three parts, lines (a) (b) (c). If a single morbid condition completely explains the deaths, then this will be written on line (a) of Part I, and nothing more need be written in the rest of Part I or in Part II, for example, smallpox, lobar pneumonia, cardiac beriberi, are sufficient cause of death and usually nothing more is needed. Often, however, a number of morbid conditions will have been present at death, and the doctor must then complete the certificate in the proper manner so that the correct underlying cause will be tabulated. First, enter in Part I(a) the immediate cause of death. This does not mean the mode of dying, e.g., heart failure, respiratory failure, etc. These terms should not be appear on the certificate at all since they are modes of dying and not causes of death. Next consider whether the immediate cause is a complication or delayed result of some other cause. If so, enter the antecedent cause in Part I, line (b). Sometimes there will be three stages in the course of events leading to death. If so, line (c) will be completed. The underlying cause to be tabulated is always written in last in Part I. Morbid conditions or injuries may be present which were not directly related to the train of events causing death but which contributed in some way to the fatal outcome. Sometimes the doctor finds it difficult to decide, especially for infant deaths, which of several independent conditions was the primary cause of death; but only one cause can be tabulated, so the doctor must decide. If the other diseases are not effects of the underlying cause, they are entered in Part II. Do not write two or more conditions on a single line. Please write the names of the diseases (in full) in the certificates as legibly as possible to avoid the risk of their being misread. Onset : Complete the column for interval between onset and death whenever possible, even if very approximately, e.g., “from birth” “several years”. Accidental or violent deaths : Both the external cause and the nature of the injury are needed and should be stated. The doctor or hospital should always be able to describe the injury, stating the part of the body injured, and should give the external cause in full when this is shown. Example : (a) Hypostatic pneumonia; (b) Fracture of neck of femur; (c) Fall from ladder at home. Maternal deaths : Be sure to answer the question on pregnancy and delivery. This information is needed for all women of child-bearing age, even though the pregnancy may have had nothing to do with the death. Old age or senility : Old age (or senility) should not be given as a cause of death if a more specific cause is known. If old age was a contributory factor, it should be entered in Part II. Example : (a) Chronic bronchitis, II old age. Completeness of information : A complete case history is not wanted, but, if the information is available, enough details should be given to enable the underlying cause to be properly classified. Example : Anaemia – Give type of anaemia, if known. Neoplasm – Indicate whether benign or malignant, and site, with site of primary neoplasm, whenever possible, Heart disease – Describe the condition specifically; if congestive heart failure, chronic on pulmonale, etc., are mentioned, give the antecedent conditions. Tetanus– Describe the antecedent injury, if known. Operation – State the condition for which the operation was performed. Dysentery – Specify whether bacillary, amoebic, etc., if known. Complications of pregnancy or delivery – Describe the complication specifically, Tuberculosis – Give organs affected. Symptomatic statement : Convulsions, diarrhea, fever, ascites, jaundice, debility, etc., are symptoms which may be due to any one of a number of different conditions. Sometimes nothing more is known, but whenever possible, give the disease which caused the symptom. In accordance with the provisions of section 10(3) of the Registration of Births and Deaths Act, 1969, a certificate of cause of death shall be given to the person required under this Act to give information concerning the death.20 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY  – 5  – 6 Form-6 /No. Form-5 /No.     GOVERNMENT OF TAMIL NADU GOVERNMENT OF TAMIL NADU DEPARTMENT OF.............../. (Name of local body issuing certificate)...... DEPARTMENT OF.............../. (Name of local body issuing certificate)......         //// BIRTH CERTIFICATE DEATH CERTIFICATE (    1969,  12/17      2025 (    1969,  12/17      2025  .8/13-  ).  .8/13-  ). (Issued under Section 12 / 17 of the Registration of Births and Deaths Act, 1969 and Rule (Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and 8 / 13 of the Tamil Nadu Registration of Births and Deaths Rules 2025 (Year of notifying the Rule 8 / 13 of the Tamil Nadu Registration of Births and Deaths Rules 2025 (Year of notifying the revised rules). revised rules).       .   .      ,    , This is to certify that the following information has been taken from the original record of death which is the register for (local area/local body) .................................................................. of This is to certify that the following information has been taken from the original record of birth which is Taluk................................ of District .................................of State of Tamil Nadu. the register for (local area/local body) .................................................................. of Taluk ................................ of District .................................of State of Tamil Nadu. /Name: .......................................................................................... /Name: .......................................................................................... /Sex................................................................................................ /Sex................................................................................................  /Date of Birth..........................................................................  /Date of Birth..........................................................................  /Place of birth.........................................................................  /Place of birth.........................................................................  /Name of Mother................................................................  /Name of Mother................................................................    /Aadhaar No. of Mother ……………………………………………    /Aadhaar No. of Mother ……………………………………………  /Name of Father ....................................................................  /Name of Father ....................................................................   / Aadhaar No. of Father ………………..……………………………….   / Aadhaar No. of Father ………………..………………………………. /  /Name of Husband / Wife……………….………..…...…      /    /   / Aadhaar No. of Husband / Wife………………………. Address of parents at the time of birth of the child : Permanent address of parents: ........................................................... ............................................................    :    Address of the deceased at the time of death: Permanent address of the deceased: ........................................................... ............................................................ ........................................................... ............................................................ ........................................................... ............................................................ ........................................................... ............................................................ ……………………………………… ………………………………………. ……………………………………..  /Registration No :.............   /Date of Registration................/  /Registration No :.............   /Date of Registration................ ()/Remarks (if any).........................   / Date of issue:.............. ()/Remarks (if any).........................   /Date of issue:......   /Signature of the issuing authority   /Signature of the issuing authority    / Address of the issuing authority    / Address of the issuing authority /Seal /Seal                 Ensure registration of every birth and death Ensure registration of every birth and deathTAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 21 –  6 Form-6 /No.   GOVERNMENT OF TAMIL NADU DEPARTMENT OF.............../. (Name of local body issuing certificate)......     DEATH CERTIFICATE (    1969,  12/17      2025  .8/13-  ). (Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and Rule 8 / 13 of the Tamil Nadu Registration of Births and Deaths Rules 2025 (Year of notifying the revised rules).    .  இறப்பு    , This is to certify that the following information has been taken from the original record of death which is the register for (local area/local body) .................................................................. of Taluk................................ of District .................................of State of Tamil Nadu. /Name: .......................................................................................... /Sex................................................................................................ இறந்த தேததி//DDaattee ooff DBeirathth.. ........................................................................ இஇறறந்ந்தத இடம்//PPllaaccee ooff bDiretha.t.h.. .....................................................................  /Name of Mother................................................................    /Aadhaar No. of Mother ……………………………………………  /Name of Father ....................................................................   / Aadhaar No. of Father ………………..………………………………. /  /Name of Husband / Wife……………….………..…...… /   / Aadhaar No. of Husband / Wife……………………….    :    Address of the deceased at the time of death: Permanent address of the deceased: ........................................................... ............................................................ ........................................................... ............................................................ ……………………………………..  /Registration No :.............   /Date of Registration................ ()/Remarks (if any).........................   /Date of issue:......   /Signature of the issuing authority    / Address of the issuing authority /Seal         Ensure registration of every birth and death22 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM 7 (See rule 12) BIRTH REGISTER Legal information This part to be added to the Birth Register To be filled by the informant 1. Date of Birth: D D - M M - Y Y Y Y 2. Sex (Enter “Male” or “Female” or “Transgender person”) : 3. Child’s Details (If not named, leave blank) :- (a) Name, if any : First Name Middle Name Last Name (b) A adhaar No, if available: 4. Father’s Details:- (a) Name: First Name Middle Name Last Name (b) (c) A Ma od bh ila ea Nr oN :o ., if avai labl e: (d) Email Id: 5. Mother’s Details:- (a) Name: First Name Middle Name Last Name ( (b c)) Aadhaar No., if available: Mobile No: (d) Email Id: 6. Address of parents at the time of Birth of the Child: House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: Permanent address of parents: House No: 7. Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 8. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 9. Informant’s Details: (a) N ame: First Name Middle Name Last Name ( (b c)) Aadhaar No., if available: (d) Mobile No: (e) E Am dda ril e I sd s: : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: DECLARATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 23, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. : Registration Date: D D - M M - Y Y Y Y Registration Unit : Town / Village: Taluk: District: Remarks ( if any): Name and Signature of the Registrar FORM .8 (See rule 12) DEATH REGISTER Legal information This part to be added to the Death Register To be filled by the informant 1. Date of Death D D - M M - Y Y Y Y 2. Deceased’s Details:- (a) Name: First Name Middle Name Last Name (b) A adhaar No, if available: (c) Date of Birth : D D - M M - Y Y Y Y (d) Age: 3. Sex (Enter “Male” or “Female” or “Transgender person”) : Mother’s Details:- 4. (a) Name: First Name Middle Name Last Name (b) Aadhaar No, if available: (c) Mobile No: (d) Email Id: 5. Father’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 6. Spouse’s (husband / wife) Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Date of Birth : D D - M M - Y Y Y Y (d) Age (in completed years): (e) Mobile No: (f) Email Id: Address of the deceased at the time of death: House No: 7. Locality: Ward number if available: Town or Village: Taluk: District: State : PIN Code: 8. Permanent address of the deceased: House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 9. Place of death (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 10. Informant’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: (e) Address : House No.: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: DECLAR ATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. To the best of my knowledge and information, the detail of Aadhaar of the deceased is not available. (After completing all columns 1 to 21, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. : Registration Date: D D - M M - Y Y Y Y Registration Unit : Town / Village: Taluk: District: Remarks ( if any): Cause of death (As per Form 4 / 4A): Name and Signature of the RegistrarTAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 23 FORM .8 (See rule 12) DEATH REGISTER Legal information This part to be added to the Death Register To be filled by the informant 1. Date of Death D D - M M - Y Y Y Y 2. Deceased’s Details:- (a) Name: First Name Middle Name Last Name (b) A adhaar No, if available: (c) Date of Birth : D D - M M - Y Y Y Y (d) Age: 3. Sex (Enter “Male” or “Female” or “Transgender person”) : Mother’s Details:- 4. (a) Name: First Name Middle Name Last Name (b) Aadhaar No, if available: (c) Mobile No: (d) Email Id: 5. Father’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 6. Spouse’s (husband / wife) Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Date of Birth : D D - M M - Y Y Y Y (d) Age (in completed years): (e) Mobile No: (f) Email Id: Address of the deceased at the time of death: House No: 7. Locality: Ward number if available: Town or Village: Taluk: District: State : PIN Code: 8. Permanent address of the deceased: House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 9. Place of death (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 10. Informant’s Details:- (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: (e) Address : House No.: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: DECLAR ATION: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. To the best of my knowledge and information, the detail of Aadhaar of the deceased is not available. (After completing all columns 1 to 21, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. : Registration Date: D D - M M - Y Y Y Y Registration Unit : Town / Village: Taluk: District: Remarks ( if any): Cause of death (As per Form 4 / 4A): Name and Signature of the Registrar24 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM.9 (See rule 12) STILL BIRTH REGISTER Legal information This part to be added to the Birth Register To be filled by the informant 1. Date of Birth : D D - M M - Y Y Y Y 2. Sex (Enter “Male” or “Female” or “Transgender person”) : 3. Father’s Details:- (a) N ame: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 4. Mother’s Details:- (a) (b) Name: First Name Middle Name Last Name (c) Aadhaar No., if available: (d) Mobile No: Email Id: 5. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No. Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 6. Informant’s Details: (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: (e) Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: DECLARATIO N: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 12, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. : Registration Date: D D - M M - Y Y Y Y Registration Unit : Town / Village: Taluk: District: Remarks ( if any): Name and Signature of the Registrar FORM .10 (See rule 13) NON-AVAILABILITY CERTIFICATE This is to certify that a search has been made on the request of Shri/Smt./Kum………………………..……………………………………………. son/wife/daughter of …………..…………………………………………….. in the registration records for the year(s) …………………………. relating to (Local area)…………………………………………………… of Taluk ……………………………………….……….. of (District) ……………….……………. of (State) ………………….……………….. and found that the event relating to the birth/death of ………………………………………… son/daughter of ….……………………………… was not registered. Date : d d - m m - y y y y Signature of issuing authority SealTAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 25 FORM.9 (See rule 12) STILL BIRTH REGISTER Legal information This part to be added to the Birth Register To be filled by the informant 1. Date of Birth : D D - M M - Y Y Y Y 2. Sex (Enter “Male” or “Female” or “Transgender person”) : 3. Father’s Details:- (a) N ame: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: 4. Mother’s Details:- (a) (b) Name: First Name Middle Name Last Name (c) Aadhaar No., if available: (d) Mobile No: Email Id: 5. Place of birth (Tick the appropriate entry 1 or 2 or 3 below and give the name and address of the “Hospital / Institution” or the address of the “House” or ‘Other place” where the birth took place) : 1.Hospital / Institution Name : 2. House 3. Other place Address : House No. Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: 6. Informant’s Details: (a) Name: First Name Middle Name Last Name (b) Aadhaar No., if available: (c) Mobile No: (d) Email Id: (e) Address : House No: Locality: Ward number if available: Town or Village: Taluk: District: State: PIN Code: DECLARATIO N: I have furnished true information to the best of my knowledge and belief. I am aware of the penalties under section 23 of the Registration of Births and Deaths Act, 1969 for submitting false information. Also, I give consent, under Aadhaar (Targeted Delivery of Financial and Other Subsidies, benefits and Services) Act, 2016, for authenticating identity by way of Aadhaar authentication. (After completing all columns 1 to 12, informant will put date and signature) Date: D D - M M - Y Y Y Y Signature or left thumb mark of the informant To be filled by the Registrar Registration No. : Registration Date: D D - M M - Y Y Y Y Registration Unit : Town / Village: Taluk: District: Remarks ( if any): Name and Signature of the Registrar FORM .10 (See rule 13) NON-AVAILABILITY CERTIFICATE This is to certify that a search has been made on the request of Shri/Smt./Kum………………………..……………………………………………. son/wife/daughter of …………..…………………………………………….. in the registration records for the year(s) …………………………. relating to (Local area)…………………………………………………… of Taluk ……………………………………….……….. of (District) ……………….……………. of (State) ………………….……………….. and found that the event relating to the birth/death of ………………………………………… son/daughter of ….……………………………… was not registered. Date : d d - m m - y y y y Signature of issuing authority Seal26 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY FORM 11 FORM 12 (See rule 14) (See rule 14) SUMMARY MONTHLY REPORT OF BIRTHS SUMMARY MONTHLY REPORT OF DEATHS 1. Report for the Month of: _____________ Year :_____________ 1. Report for the Month of: ______________ Year _____________ 2. District: 2. District: 3. Town / Village: 3. Town / Village: 4. Registration Unit: 4. Registration Unit: 5. Number of Births Registered during the month: 5. Details of Deaths Registered during the Month: Male Female Transgender Person Total* Deaths (Including all Infant deaths & Infants Deaths (Age less than one year) Child Deaths (Age one year or more but Maternal (1) (2) (3) (1+2+3) Child Deaths& Maternal Deaths) less than five years) Deaths Male Female Transgender Total* Male Female Transgender Total Male Female Transgender Total Person Person Person 6. Time Gap in Birth registration: (a) Within Time limit (21 days) of their occurrence: 6. Time Gap in Death registration: (b) More than 21 days but within 30 days of their occurrence: (a) Within Time limit (21 days) of their occurrence: (c) More than 30 days but within one year of their occurrence: (b) More than 21 days but within 30 days of their occurrence: (d) After one year of their occurrence: (c) More than 30 days but within one year of their occurrence: (d) After one year of their occurrence: Total* (a + b + c + d): Total* (a + b + c + d): * Total should be equal to the number of statistical part of Birth Report Forms (Form 1) attached with this monthly report. Note: Infant and Child Deaths &Maternal Deaths should also be included in the Deaths. * Total should be equal to the number of statistical part of Death Report Forms (Form 2) attached with this monthly report. Signature and Name of the Registrar Signature and Name Date : d d - m m - y y y y of the Registrar Date : d d - m m - y y y y Submitted to the Chief Registrar/District Registrar Submitted to the Chief Registrar/District RegistrarTAMIL NADU GOVERNMENT GAZ ETTE EXTRAORDINARY 27 FORM 12 (See rule 14) SUMMARY MONTHLY REPORT OF DEATHS 1. Report for the Month of: ______________ Year _____________ 2. District: 3. Town / Village: 4. Registration Unit: 5. Details of Deaths Registered during the Month: Deaths (Including all Infant deaths & Infants Deaths (Age less than one year) Child Deaths (Age one year or more but Maternal Child Deaths& Maternal Deaths) less than five years) Deaths Male Female Transgender Total* Male Female Transgender Total Male Female Transgender Total Person Person Person 6. Time Gap in Death registration: (a) Within Time limit (21 days) of their occurrence: (b) More than 21 days but within 30 days of their occurrence: (c) More than 30 days but within one year of their occurrence: (d) After one year of their occurrence: Total* (a + b + c + d): Note: Infant and Child Deaths &Maternal Deaths should also be included in the Deaths. * Total should be equal to the number of statistical part of Death Report Forms (Form 2) attached with this monthly report. Signature and Name of the Registrar Date : d d - m m - y y y y Submitted to the Chief Registrar/District Registrar28 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Form 14 FORM 13 (See rule 9) (See rule 14) SUMMARY MONTHLY REPORT OF STILL BIRTHS Format of Self-attested document for Delayed Reporting of BIRTH / DEATH under section 13(2) of the Registration of Births and Deaths Act, 1969 1. Report for the Month of: _____________ Year :_____________ DECLARATION 2. District: I…………………………………………………………,son/daughter/wife of …………….,resident of …………………………………………………………………………. do hereby declare that: 3. Town/ Village: 1. I am the informant for the delayed reporting of Birth / Death of_____(name of child / 4. Registration Unit: deceased)________________________son/daughter/spouse of ………………………………….; 2. He / she was born / died on ___(date of birth / death)_________________________ at (place of 4. Number of Still Births Registered during the month: birth / death)…………….; 3. He / she was attended at birth /death by _________________________ who resides at___________; Male Female Transgender Person Total* 4. The reason(s) for the delay in reporting of his / her birth /death are (1) (2) (3) (1+2+3) ______________________________________________________________________________ ________________________________; 5. His / her birth / death certificate is required for the purpose of 5. Time Gap in Birth registration: ________________________________; (a) Within Time limit (21 days) of their occurrence: (b) More than 21 days but within 30 days of their occurrence: DECLARATION: (c) More than 30 days but within one year of their occurrence: I, declare that the above information is true and I have not reported the above event to any (d) After one year of their occurrence: Registrar and no birth / death certificate has been issued in this respect, to the best of my knowledge and belief. Total* (a + b + c + d): Name and Signature or thumb mark of the informant * Total should be equal to the number of statistical part of Still Birth Report Forms (Form 3) attached with this monthly report. Date D D - M M - Y Y Y Y Notes: Signature and Name 1. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, of the Registrar mm is month in two digits and yyyy is year in four digits Wherever the date is written in words it Date : d d - m m - y y y y should be written in full e.g 01-01-2023 shall be written as First January two thousand twenty three. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. Submitted to the Chief Registrar/District Registrar 2. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name]. 3. Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 29 Form 14 (See rule 9) Format of Self-attested document for Delayed Reporting of BIRTH / DEATH under section 13(2) of the Registration of Births and Deaths Act, 1969 DECLARATION I…………………………………………………………,son/daughter/wife of …………….,resident of …………………………………………………………………………. do hereby declare that: 1. I am the informant for the delayed reporting of Birth / Death of_____(name of child / deceased)________________________son/daughter/spouse of ………………………………….; 2. He / she was born / died on ___(date of birth / death)_________________________ at (place of birth / death)…………….; 3. He / she was attended at birth /death by _________________________ who resides at___________; 4. The reason(s) for the delay in reporting of his / her birth /death are ______________________________________________________________________________ ________________________________; 5. His / her birth / death certificate is required for the purpose of ________________________________; DECLARATION: I, declare that the above information is true and I have not reported the above event to any Registrar and no birth / death certificate has been issued in this respect, to the best of my knowledge and belief. Name and Signature or thumb mark of the informant Date D D - M M - Y Y Y Y Notes: 1. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits Wherever the date is written in words it should be written in full e.g 01-01-2023 shall be written as First January two thousand twenty three. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 2. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. There should be minimum two characters in either [first name] or [middle name] or [last name]. 3. Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.30 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY Form 15 (See rule 12) CONTROL REGISTER FOR THE YEAR (PART A) Name of Taluk / Panchayat Union: fo emaN /stayahcnaP nwoT/egalliV January February March April May June July August September October November December tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD Form 16 (See rule 17) FORM FOR APPEAL (To be submitted to District Registrar / Chief Registrar) (under Section 25(A) of the Registration of Births and Deaths Act, 1969) 1. Aggrieved by an action or order of: Registrar / District Registrar (details of office to be provided as below) State District Taluk Village/Town Locality RU Name of (Sub- ID Registrar / Distt. Registrar district) 2. Account of Event Leading to appeal with date and order no. etc. (Provide a detailed account of the occurrence, use attachments, if necessary) DECLARATION: I have furnished true information to the best of my knowledge and belief. (Signature of the appellant) Date D D - M M - Y Y Y Y Appellant details: Name Address Aadhaar no. Email Id Mobile No. -------------------------------------------------------------------------------------------------------------------------------- Notes: 1. Please retain a copy of this form for your own records. 2. Appeal, if any, must be submitted to District Registrar / Chief Registrar within a period of 30 days from the date of such action or receipt of such order with which the person is being aggrieved. 3. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 4. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 5. Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY 31 Form 15 (See rule 12) CONTROL REGISTER FOR THE YEAR (PART A) Name of Taluk / Panchayat Union: fo emaN /stayahcnaP nwoT/egalliV January February March April May June July August September October November December tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD tpieceR fo etaD hctapseD fo etaD Form 16 (See rule 17) FORM FOR APPEAL (To be submitted to District Registrar / Chief Registrar) (under Section 25(A) of the Registration of Births and Deaths Act, 1969) 1. Aggrieved by an action or order of: Registrar / District Registrar (details of office to be provided as below) State District Taluk Village/Town Locality RU Name of (Sub- ID Registrar / Distt. Registrar district) 2. Account of Event Leading to appeal with date and order no. etc. (Provide a detailed account of the occurrence, use attachments, if necessary) DECLARATION: I have furnished true information to the best of my knowledge and belief. (Signature of the appellant) Date D D - M M - Y Y Y Y Appellant details: Name Address Aadhaar no. Email Id Mobile No. -------------------------------------------------------------------------------------------------------------------------------- Notes: 1. Please retain a copy of this form for your own records. 2. Appeal, if any, must be submitted to District Registrar / Chief Registrar within a period of 30 days from the date of such action or receipt of such order with which the person is being aggrieved. 3. Date, wherever it occurs, is to be provided in dd-mm-yyyy format, where dd is date in two digits, mm is month in two digits and yyyy is year in four digits e.g 01-01-2023. Use only 'Arabic numerals' such as 0,1,2,3,4,5,6,7,8,9 for recording dates and other numerical entries. 4. Name, wherever it occurs, is to be provided in the format of [first name] [middle name] [last name] where full name (not abbreviation) to be written in capital letters and first name is mandatory. 5. Address, wherever it occurs, shall contain the name of State, District, Taluk (Sub-district), Town or Village, Ward number (in case of town and if available), Locality, House number and PIN Code.32 TAMIL NADU GOVERNMENT GAZETTE EXTRAORDINARY ANNEXURE (See rule 4) REPORT ON THE WORKING OF THE ACT 1. Brief description of State, its boundaries and revenue districts. 2. Changes in Administrative Areas. 3. Explanation about the differences in Areas. 4. Changes in Registration Area - Extension. 5. Administrative set up of the registration machinery at various levels. 6. General response of the public towards this Act. 7. Notification of births and deaths. 8. Progress in the Medical Certification of Cause of Death. 9. Maintenance of Records. 10. Search of births and deaths register for issue of certificates. 11. Delayed registrations. 12. Prosecutions and compounding of offences. 13. Difficulties encountered in implementation of the Act. (i) Administrative. (ii)Others. 14. Orders and Instruction issued under the Act. 15. General remarks. P. SENTHILKUMAR, P.SENTPHrinILcipKaUl SMeAcreRta, ry to Government. PRINCIPAL SECRETARY TO GOVERNMENT //True Copy// SECTION OFFICER PRINTED AND PUBLISHED BY THE COMMISSIONER OF STATIONERY AND PRINTING, CHENNAI ON BEHALF OF THE GOVERNMENT OF TAMIL NADU