Application Nunhe CERTIFIED to be a true copy of an entry in the certified copy of* a register of Births, Still-births or Deaths the Sea in the District above mentioned. Given at the GENERAL REGISTER OFFICE, under Se beabeeoe 15th October 2021 n fre f Register, the wor he certified copy ick oul UTION: THERE ARE OFFENCES RELATING TO FALSIFYING OR ALTERING A CERTIFICATE \ND USING OR POSSESSING A FALSE CERTIFICATE CROWN COPYRIGHT CERTIFIED COPY OF AN ENTRY NHS Number Adns‘nistrative erea F. -yistration district Sub-distict 1. Date and place of birth "2. Namo and surname 4, Name and surnamo 6, Ptoce of birth 7. Name ond surnaino . Place of birt 9.(0) Molden sumamo if difforant from maidon surname 10, Usual oddress (if differont from place of child’s birth 11. Nemo and surnamo (if not the muther ox father) . Qualification ea a ie Da 13, Usual addros: (if difforent from that in 10 above) f 14. leanify thatthe : rua to tho best of my «...wlodge and belief a Signature ot informant | 18. vat | ~ | ! S jok r {ADL a ddeaaeennneme | 1 t WARNING: A CERTIFICATE IS NOT EVIDENCE OF IDENTITY. EFTA00088944