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Vital form

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4 views

Vital form

Used by teachers

Uploaded by

vincentakayombokwa
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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CS Form B26

REPUBLIC OF ZAMBIA
FORM OF VITAL STATISTICT
(General Order No. 10)

1. Name of Officer in full ……………………………………………………………………………

2. Date of birth ……………………………………………………………………………………….

3. Place of birth ………………………………………………………………………………………

Nationality of parents: Father …………………………………. Mother …………………………

4. Religion ……………………………………………………………………………………………

5. Title of appointment ……………………………………………………………………………….

6. Date of marriage …………………………………...Date of birth of wife ………………………..

Maiden and Christian names of wife ……………………………………………………………….


8 Children
Date of birth Name Sex Remarks

9. (To be completed by married women only)


Name of husband in full ………………………………………………………………………………

Address of husband …………………………………………………………………………………..

………………………………………………………………………………………………………..

Husband’s present occupation ………………………………………………………………………..

10. Name and address of parents and / or other relations or friends whom you would wish to be
notified in the invent of serious illness or other emergency.

a) Name ……………………………………………………………………………

Address…………………………………………………………………………

Relationship …………………………………………………………………….

b) Name ……………………………………………………………………………

Address…………………………………………………………………………..

Relationship ……………………………………………………………………..

Date ……………………………… Signature ……………………………..


Note- The permanent Secretary (Personnel) must be informed if any amendments to the details give above become necessary

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