NATIVITY CERTIFICATE

 

Certified that Sri………………………………...…………………………………………..

 

Son/daughter of sri……………………………………………………...…………………..

 

House…………………………………………Amsam…………………………………….

 

Desam…………………………………………Taluk…………………….……………….

 

District………………………………………………..has been a resident of the village of

 

……………………………………………………..…..of Kerala State continuously for a

 

Period of more than ………………………….………..years and is native of Kerala State.

 

Place………….

Date………….                Signature of the issuing authority

with Designation in full