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43 views1 page

MPDF

Thanks

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cppt76305
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सं.

1 उर देश सरकार प-5


NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाम पंचायत सेमरा हरदो पट
GRAMA PANCHAYAT SEMRA HARDO PATTI

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क ाम पंचायत सेमरा हरदो पट तहसील तमकुह राज िजला
कुशीनगर राय/संघ देश उर देश, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE
REGISTER FOR GRAMA PANCHAYAT SEMRA HARDO PATTI OF TAHSIL/BLOCK TAMKUHI RAJ OF DISTRICT KUSHINAGAR OF STATE/UNION
TERRITORY UTTAR PRADESH, INDIA.

नाम / NAME: SHWATI लंग / SEX: महला / FEMALE

जम तथ / DATE OF BIRTH:


जम थान/ PLACE OF BIRTH:
20-03-2016
BELSADI
TWENTIETH-MARCH-TWO THOUSAND SIXTEEN

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:


SHISHAM BABLU

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD: BELSADI BELSADI KASIMABAD GHAZIPUR,UTTAR PRADESH
BELSADI BELSADI KASIMABAD GHAZIPUR,UTTAR PRADESH 233302 233302

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:


B -2024: 9-41347 -0000980 20-03-2016

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
07-04-2024
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत सेमरा हरदो पट
GRAMA PANCHAYAT SEMRA HARDO PATTI

UPDATED ON :
07-04-2024 20:29:49

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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