Your First name/Last name

Address

Postal code/ CITY

Town Hall

Address

Postal code/City

Done in [your city], on [specify the date].

Subject: Request for a birth certificate extract

Madam, Sir,

I would be grateful if you could send me an extract of my birth certificate.

I was born on [indicate your date of birth].

Please send it to the address shown in the letterhead.

Waiting for your reply, please accept, Madam, Sir, the expression of my best regards.

 [Your signature]