APPLICATION FOR A BIRTH CERTIFICATE PLEASE READ THESE NOTES before completing this form.

Birth Certificate Prescot : PRE/40/54

1 TO BE COMPLETED BY THE APPLICANT Name of applicant Mr Mrs Miss/Ms (STATE NAME IN FULL) Full postal address   Post Code: Telephone no: e-mail address:

2 Are you applying for your own birth certificate? Yes/No If not please state your relationship to the person:

3 DETAILS OF BIRTH CERTIFICATE REQUIRED
FULL NAME AT BIRTH			FATHER'S FULL NAME	MOTHER'S FULL NAME
FORENAME(S) Frederick			FORENAME(S)	FORENAME(S)
SURNAME GRIFFITH			SURNAME	SURNAME
				MAIDEN SURNAME
DATE OF BIRTH			PLACE OF BIRTH (Full address or name of hospital)
DAY	MONTH	YEAR 1877	Prescot

4 REQUIREMENTS	Send this Application to:
BIRTH CERTIFICATE £11.00	Superintendent Registrar, Prescot Register Office, Council Offices, High Street, Prescot, L34 3LH
I requireNUMBER birth certificate(s)

5 REMITTANCE ENCLOSED  (POSTAL APPLICATIONS ONLY)

UK: applications should enclose an SAE. Postal order or cheque made payable to : Knowsley Borough Council for £ 11.00 Overseas: applications should enclose a self addressed envelope and two IRCs, with payment by Bankers Sterling Draft payable to : Knowsley Borough Council

The Fee for a certificate issued against this form 'as printed' will not be refunded. You are strongly recommended to add any qualifying information you may have in order to help the registrar issue the correct certificate.