1950_BIRTHS_AND_DEATHS_REGISTRATION_ORDINANCE — Page 17

J

h

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.