1964_BIRTHS_AND_DEATHS_REGISTRATION_ORDINANCE — Page 20

1986 Ed.]

Births and Deaths Registration

[CAP.174

19

FORM 13

[s. 18(a).]

Certificate of still-birth

1, A.B., registered medical practitioner in Hong Kong, hereby certify that I was in attendance at the birth of the child of Mrs. C.D. [or have examined the body of the child of Mrs. C.D.] and that such child was not born alive.

Dated the

I, A.B., of

本人某甲現居於

day of

.19

(Signed.)A.B., Registered medical practitioner. ( Amended, 67 of 1984, s. 10)

FORM 14

[s. 18(b).]

表格十四

〔條例第一八條(乙)款]

Declaration as to still-birth

有關死產之聲明書

solemnly and sincerely declare that no registered medical practitioner was present

謹 以 至 誠 聲 明

當 某 乙 女 士 於 at the birth of the child of Mrs. C.D. which aceured on the

虎

of

時

年

月

day

日 分 娩 19........., (or that E.F., registered medical 並 無 註 册 醫 生 在 場 (或註 practitioner, was present at the birth of the child of Mrs. C.D. which occurred 册 醫 生 某 丙 在 某 乙

on the 九

day of ...

年

月

女

土 於

19..

but that his certificate 日分娩時在場 惟未能

缔

according to Form 13 in the Second Schedule to the Births and Deaths Registration 獲其依照生死註冊條例(香港法例第 七四章 )

Ordinance, (Chapter 174), cannot be obtained) and that the child of Mrs. C.D. 第二附表內表格十三發給證書) 此外 某乙女

which was born on the

士於一九

born alive.

已死亡。

年

◊

day of 月

19..

was not 日所分娩之嬰兒在出世時經

And I make this solemn declaration conscientiously believing the same to be 本人謹根據宣誓及聲明條例, 表誠提出此 true and by virtue of the Oaths and Declarations Ordinance. 項聲明,並確信其為真實無訛

(Signed)A.B. (簽署) 某甲

Legal Informant. 法定呈報人

(Cap. 11.)

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