89 / 92
CHILD CAKEAND PROTECTION
It is hereby declared that-
(1) The age of the said cluld is
................
......
(6).
.............
.years
.months. being born on
( 6 )
(2) his religious persuasion is (7)
...........................
:
(3) a coutributionorder in the sum of (8).
......
,
.........
.a week payable
by (9).
..................
being the (9)..
................
of the said child
has been made.
A record in accordance with the provisions of the Child Carc and Protection
Act is forwarded herewith.
Given under my hand this (10)
............
.....day
or..
.......................
a1
(11)
..........................
in the parish of (3)
.....................................
(12)
....................................
The fit person to whose care the said child shall be committed is
(13).
...........................................................................
Dated this
(10).
................................
(14).
........................................
The said child shall be transferred from the care of the abovc-named fit
person to the care of (13)
.................................................
Dated this
............................
(14)
............................
State full namc.
Amend. if necessary.
State name of parish.
Strike out the inapplicable alternatives.
State nature of offence.
State age and date of birth.
State religious persuasion. if ascertainable.
State amount, if contributionorder made.
State name
and
status of person by whom contributions payable if
contributionorder made.
State date.
State place.
Signatureof the proper officer of the cow.
State name of fit person willing to undertake the care of the child.
Signatureof person authorized by the Minister.
[The inclusion of this
page
is authorized
by
L.N.
1 1
1/20015]