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Form 1 Birth

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.

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Peterson Mathius
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3K views2 pages

Form 1 Birth

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.

Uploaded by

Peterson Mathius
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on 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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