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Regulation 3(a) and 4
Birth Registered in the District of
in the Superintendent Registrar’s district of
in the county of
Entry number
Date and Place of birth
Name (if any) (child’s forename(s))
Sex
Name and Surname and Dwelling-place of Father
Name and Surname and Maiden Surname of Mother
Rank or Profession of Father
Signature, Qualification and Residence of Informant
When Registered
Signature of Registrar
Baptismal Name if added after Registration of Birth and Date
Birth registered in the district of | |
Child | – Surname |
– Name | |
– Sex | |
– Date of birth | |
– District of birth | |
– Place of birth | |
Father | – Name and surname |
– Occupation | |
Mother | – Name and surname |
– Usual address | |
– Maiden surname | |
– Surname at marriage (if different from maiden surname) | |
Informant | – Qualification |
– Address | |
– Signature | |
Date of registration | |
Signature of Registrar |
Birth registered in the district of | |
Child | – Surname |
– Name | |
– Sex | |
– Date of birth | |
– District of birth | |
– Place of birth | |
Father | – Name and surname |
– Occupation | |
Mother | – Name and surname |
– Occupation | |
– Usual address | |
– Maiden surname | |
– Surname at marriage (if different from maiden surname) | |
Informant | – Qualification |
– Address | |
– Signature | |
Date of registration | |
Signature of Registrar |
Regulation 3(b)
No. of Entry
Date of Entry
Name (not including surname) by which it is intended that the Adopted Child shall be known.
Sex of Adopted Child.
Name and Surname, Address and Occupation of Adopter or Adopters.
Date of Birth of Child, and if Birthplace is not in Northern Ireland, Country of Birth.
Date of Adoption Order and Description of Court by which made.
Signature of Officer deputed by Registrar General to attest the Entry.
No. of entry
Date of birth of child, and if birthplace is not in Northern Ireland, country of birth
Name and surname of child
Sex of child
Name and surname, address and occupation of adopter or adopters
Date of adoption order and description of court by which made
Date of entry
Signature of officer deputed by Registrar General to attest the entry.
No. of entry
Date and country of birth of child and in the case of an infant born in Northern Ireland, the district of the Superintendent Registrar and/or the Registrar of Births and Deaths in which the birth took place or the district of the Superintendent Registrar and/or the Registrar of Births and Deaths where the court, that made the adoption order, sits.
Name and surname of child
Sex of child
Name and surname, address and occupation of adopter or adopters
Date of adoption order and description of court by which made
Date of entry
Signature of officer deputed by Registrar General to attest the entry.
No. of entry
Date and country of birth of child and in the case of a child born in Northern Ireland, the registration district in which the birth took place or the registration district where the court, that made the adoption order, sits.
Name and surname of child
Sex of child
Name and surname, address and occupation of adopter or adopters
Date of adoption order and description of court by which made
Date of entry
Signature of officer deputed by Registrar General to attest the entry.
Regulation 3(c)
No. of entry
Date and country of birth of child and in the case of a child born in Northern Ireland, the registration district in which the birth took place.
Name and surname of child
Sex of child
Name and surname, address and occupation of persons who obtained the Parental Order
Date of Parental Order and description of court by which made
Date of entry
Signature of officer deputed by Registrar General to attest the entry.
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