Delayed Birth Registration Affidavit for Hospital Delivery with Missing Registration Entry

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 for Hospital Delivery with Missing Registration Entry 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 the child [Child Name] was delivered on [Date of Birth] at the Sub-Divisional Hospital. 2. That the institutional discharge card was preserved, but the local registrar failed to record the entry in the statutory register. 3. That a formal Non-Availability of Birth Certificate (NABC) has been issued by the local municipal office. 4. That I pray for an order from the Ld. Executive Magistrate directing the Concerned Authority to record the delayed registration. Verification:- I, the above-named deponent, do hereby verify and declare that the statements made in paragraphs 1 to 4 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