Document Format Of Surrender (Single Parent)

Document Format Of Surrender (Single Parent)
Document Format Of Surrender (Single Parent)

I, ——– aged ——- do hereby state as follows:

  1. I delivered a child on ——- at ——. The said child is born out of wedlock and has been in my guardianship and custody thereafter.
  2. I request the authorities not to disclose my full identity or address or whereabouts and do not wish to give any information of the father, or other relatives of the said child, because of social reasons.
  3. I am the sole guardian of the said child and there is no other lawful guardian or father for the said child.
  4. I say that I was helped by the authorities of Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Colaba, Bombay 400 039 to understand all implications of adoption of my child and I was specifically told that in case the minor whom I am abandoning, if adopted, I shall have no further contact with the minor. I have made this decision of abandoning the minor after due thought and consideration.
  5. I say that I, without receiving any monetary and material consideration voluntarily of my own free will and volition and without any inducement, influence, coercion or fraud and without being under the influence of any person, drink or drug, have today handed over my aforesaid child to Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Bombay 400 039 with the authority to Family Service Centre, Bombay to place the said child in adoption / guardianship with any suitable people.
  6. I say that I have abandoned the said child because I am unable to look after, maintain, educate and bring up the child and have no relative, friend willing to do so. I further say that I was explained and given to understand that I can claim my child within three months from today. I have further been explained that if I do not reclaim my child during this period of three months the agency will be free to rehabilitate the child at its own discretion either in India or abroad. I further state that should any untoward event occur with regard to the child when in the agency’s foster care, I shall not hold the agency responsible.
  7. I hereby declare that I have relinquished all my rights and claims to the said child and all reciprocal rights, claims and/or obligations of the parent and child between me and the said child are terminated. The authorities of Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Bombay 400 039, may in their discretion place the said child into any good family irrespective of religion, in India /abroad, or transfer the child to any institution for the purpose of adoption/guardianship or any suitable rehabilitation.
  • *The sample documents are derived from the records of the Family Service Centre,Bombay.

8. I request the authorities of Family Service Centre, Bombay, not to disclose my name and identity, known to them, to person or persons or authority at any time and under any circumstances.
Read over and explained by me-

Full name:
Designation:
Address:
Witnessed by:
Full name:
Designation:
Address:
Dated this day of 1992:
Natural mother’s name , signature/thumb impression:
Signature.thumb impression of natural mother’s relative:

Format of Document for Surrender (Married Couple)

  1. Format of Document for Surrender (Married Couple)
    Format of Document for Surrender (Married Couple)

    We, Mr. ——–, aged — years and Mrs. ———-, aged — years do hereby state as follows :

  2. We have been married for five years. We have two children, a female child aged four years, and a male child aged one and a half years. We say that with much thought and consideration, we have decided to give up our third child, that is, a female child, born on ——–, in adoption. We are the sole guardians of the child and there is no other lawful guardian for the said child.
  3. I am working as a newspaper vendor at Dadar and have no permanent shelter. My wife is in long-term hospital care since she is suffering from an advanced stage of tuberculosis which is terminal. My wife and I are finding it very difficult to provide for and look after three children. We have been explained that some kind of support and foster care can be arranged by Family Service Centre, in case we do not wish to abandon this child. However, in the best interests of the child, we have decided, by our own free will, to give up the said baby girl in adoption.
  4. We say that we are helped by the authorities of Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Colaba, Bombay 400 039, to understand all implications of adoption of our child and we were specifically told that in case the minor whom we are abandoning, if adopted,we shall have no further contact with the minor.
  5. We request the authorities not to disclose our full identity or address or whereabout and do not wish to give any information of ourselves because of social reasons.
  6. We are aware that the Family Service Centre will act in the best interests of the child. However, in unforseeable circumstances, we shall not hold the agency responsible.
  7. We say that without receiving any monetary and material consideration voluntarily, of our own free will and volition and without inducement, influence, coercion, or fraud and without being under the influence of any person, drink or drug, have handed over our aforementioned child to Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Colaba, Bombay 400 039, with the authority to Family Service Centre, Bombay, to place the said child in adoption / guardianship with any suitable couple.
  8. We say that we have abandoned the said child because we are unable to look after, maintain, educate and bring up the said child and have no relative or friend willing to do so. We further say that we were explained and given to understand that we can claim our child within four months from today. We have further been explained that if we do not reclaim our child during this period of four months, the agency will be free to rehabilitate the child at its own discretion either in India or abroad.
  9. We hereby declare that we have relinquished all our rights and claims to the said child and all reciprocal rights, claims and / or obligations of the parent and child between us and the child are terminated. The authorities of Family Service Centre, Eucharistic Congress Building Number 3, 5 Convent Street, Bombay 400 039, may at their discretion place the said child into any good family irrespective of religion, in India / abroad or transfer the child to any institution for the purpose of adoption / guardianship or any suitable rehabilitation.
  10. We request the authorities of Family Service Centre, Bombay, not to disclose our name and identity, known to them, to person or persons or authority at any time and under any circumstances.

Read over and explained by me-

Full name:
Designation:
Address:
Witnessed by:
Full Name:
Designation:
Address :
Witnessed by:
Full Name:
Relative of natural parents:
Address:
Natural mother’s name, signature/thumb impression:
Natural father’s name, signature/thumb impression:
Dated, this day of July 1991: