Births and Deaths Registration.
[CAP.174
一千九百卅四年生死册則例第
十一節(甲)欺
第四種格式
知悉
茲通告
之日起七日內將證書交來本署此告
而不發均由醫生痘師給予證書由證書
痘如種安或醫生痘師認爲不合種或種
起六星期內須由醫生或公衆種痘師種
規定凡在本港出世之小兒由出世之日
按照一千九百廿三年種痘則例各節之
九地
起發
百址
+
年
註生死册處啓
月
日
FORM 5.
[s. 13(1).]
Declaration for altering or adding to the name of a child.
I (Name)
(Address)
(Description)
Parent [or guardian] of the child of
and
the
day of
whose birth was registered on
under the
name(s) of
do solemnly, sincerely and
truly declare that I desire
Strike out
either (a)
or (b) as
required.
(a) to add the name(s) of
name(s).
to the above-mentioned
(b) to alter the above-mentioned name(s) to
Before me,
(Signed.)
(Signed.)
329
A.B.,
Parent [or Guardian].
Registrar.