Delayed Birth Registration Affidavit u/s 13(3) of RBD Act (Home Delivery before Magistrate)

Before the Ld. Concerned Authority / Notary Public At Ghatal, Dist.- Paschim Medinipur, West Bengal AFFIDAVIT (On Non-Judicial Stamp Paper of ₹10 Non-Judicial Stamp Paper) In the matter of: Delayed Birth Registration Affidavit u/s 13(3) of RBD Act (Home Delivery before Magistrate) I, [Deponent Name], [S/O / D/O / W/O] [Father / Husband Name], aged about [Age] years, by faith [Religion], by occupation [Occupation], residing at Vill.- [Village / Ward No.], P.O.- [Post Office], P.S.- [Police Station], Sub-Division- Ghatal, Dist.- Paschim Medinipur, Pin- [Pin Code], West Bengal, do hereby solemnly declare, affirm and state on oath as under:- 1. That I am the biological parent of the minor child [Child Name], who was born on [Date of Birth] at our residence in the village. 2. That due to domestic adversity and lack of procedural knowledge, the birth could not be notified within the statutory 365-day period. 3. That no birth certificate has been registered or issued for the child from any other municipality or panchayat across India. 4. That I submit the Gram Panchayat Pradhan certificate and immunization record as medical corroboration. 5. That I pray before this Ld. Court for an order under Section 13(3) of Act 18 of 1969 directing the Concerned Authority to register the birth. Verification:- I, the above-named deponent, do hereby verify and declare that the statements made in paragraphs 1 to 5 above are true and correct to the best of my personal knowledge, belief and derived from authentic records. No material facts have been suppressed, concealed or misstated herein. If any statement is subsequently found to be false or incorrect, I shall be liable to face statutory legal prosecution under the Indian Penal Code / Bharatiya Nyaya Sanhita and relevant provisions of Registration of Births and Deaths Act 1969 u/s 13(3). Solemnly affirmed and signed on this [Date] day of [Month], [Year] at Ghatal. ___________________________ Deponent Signature / LTI Identified by me and signed in my presence: ___________________________ Advocate, Ghatal Dewani Court Dist.- Paschim Medinipur, West Bengal