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    Form 1 Birth

    Uploaded by

    Peterson Mathius
    This document is a birth and national identity registration form from Papua New Guinea. It collects personal details about the child being registered such as name, date and place of birth, parents' details, and disability status. It also collects information to register the child for a national identity card later in life such as place of origin, current address, and education level. The form requires signatures from the registration officer and applicant/witness to certify the accuracy of the information for registration purposes under Papua New Guinea's Civil Registration Act.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form 1 Birth

    Uploaded by

    Peterson Mathius
    276 views2 pages
    This document is a birth and national identity registration form from Papua New Guinea. It collects personal details about the child being registered such as name, date and place of birth, parents' details, and disability status. It also collects information to register the child for a national identity card later in life such as place of origin, current address, and education level. The form requires signatures from the registration officer and applicant/witness to certify the accuracy of the information for registration purposes under Papua New Guinea's Civil Registration Act.

    Original Description:

    This form is the national registration form for all PNG citizens.

    Original Title

    Form-1-Birth

    Copyright

    © © All Rights Reserved

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    This document is a birth and national identity registration form from Papua New Guinea. It collects personal details about the child being registered such as name, date and place of birth, parents' details, and disability status. It also collects information to register the child for a national identity card later in life such as place of origin, current address, and education level. The form requires signatures from the registration officer and applicant/witness to certify the accuracy of the information for registration purposes under Papua New Guinea's Civil Registration Act.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    276 views2 pages

    Form 1 Birth

    Uploaded by

    Peterson Mathius
    This document is a birth and national identity registration form from Papua New Guinea. It collects personal details about the child being registered such as name, date and place of birth, parents' details, and disability status. It also collects information to register the child for a national identity card later in life such as place of origin, current address, and education level. The form requires signatures from the registration officer and applicant/witness to certify the accuracy of the information for registration purposes under Papua New Guinea's Civil Registration Act.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    INDEPENDENT STATE OF PAPUA NEW GUINEA Form 1

    Civil Registration Act (Chapter 304) Amended 2014


    BIRTH & NATIONAL IDENTITY REGISTRATION FORM
    O. For Office Use Only

    *Birth Registration: *National Identity Card Registration: *Registration Date: D D - MM - Y Y Y Y


    *Province: *LLG:

    *District: *Ward:

    *Registration Point:

    *Registration Officer's Name: *NID No:

    A. Child or Applicant's Details: PLEASE WRITE IN BLOCK LETTERS & FILL UP ALL REQUIRED INFORMATION (*)

    Birth Cert ID/NID No: *Date of Birth: D D - MM - Y Y Y Y


    *Given Name(s):
    *Family Name:
    (Name at Birth)

    Place of Birth:
    *Hospital/Village/Town:

    *Province: *LLG:

    *District: *Ward:

    *Gender: □ Male □ Female Order of Child: *Registration Type: □ Live Birth □ Still Birth
    *Registered As: □ Natural □ Adoption □ Fostered Type of Birth: □ Single □ Twins □ Triplets □ Quadruplets
    (Fill Form 4: Particulars of an Adoption)

    Disability: *Mobile No:

    B. Parents Details:
    MOTHER FATHER
    NID No:

    *Given Name(s):

    *Family Name:
    (Father's Surname)

    *Date of Birth: D D - MM - Y Y Y Y D D - MM - Y Y Y Y
    *Nationality:

    *Occupation

    *Denomination:

    Place of Origin:

    *Country:

    *Province/State:

    *District:

    *LLG:

    *Ward:

    *Village/Town:

    *Tribe:

    *Clan:
    MOTHER FATHER
    Current Residential Address:
    *Province:

    *District:

    *LLG:

    *Ward:

    *Village/Town:

    Parents Marriage Information: (Civil & Customary Marriage Only)

    Type of Marriage: □ Civil □ Customary □ Defacto Date of Marriage: D D - MM - Y Y Y Y


    Marriage Reg. No:

    C. National Identity Card Information: THIS SECTION IS TO BE COMPLETED BY APPLICANTS 18 YEARS AND ABOVE ONLY

    Place of Origin:
    *Province: *LLG:

    *District: *Ward:

    *Village/Town: *Tribe:

    *Society: □ Patrilineal □ Matrilineal *Clan:

    Current Residential Address:


    *Province: *LLG:

    *District: *Ward:

    *Village/Town:

    *Marital Status: □ Never Married □ Married □ Separated □ Divorced □ Widow/Widower


    Preferred Spouse Family Name:
    (Married Woman Only)

    Spouse NID No/Name:

    *Education: □ Never Attended School □ Elementary □ Primary □ Secondary □ Tertiary □ Others


    *Occupation:

    *Denomination:

    D. Witness Details: AUTHORIZED WITNESS ONLY - COUNCILLOR, PASTOR, CLAN LEADER, HEALTH WORKER, PROFESSIONALS

    *Given Name(s): NID No:

    *Family Name:

    Current Residential Address:


    *Province: *LLG:

    *District: *Ward:

    *Signature:
    *Village/Town:

    *Occupation: ----------------------------------------

    I hereby certify that the above information is correct for the purpose of registration under the Civil Registration Act (Chapter 304) Amended 2014

    *Registration Officer's Signature:------------------------- *Applicant's Signature/Mark:-------------------------

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