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Form 5

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Sahil kumar Shaw
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145 views

Form 5

Uploaded by

Sahil kumar Shaw
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form-5

GOVERNMENT OF WEST BENGAL


DEPARTMENT OF HEALTH AND FAMILY WELFARE

CHITTARANJAN SEVA SADAN COLLEGE OF OBS GYNAE &


CHILD HEALTH

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR CHITTARANJAN SEVA SADAN COLLEGE OF OBS GYNAE & CHILD HEALTH OF BLOCK/MUNICIPALITY
KOLKATA MUNICIPAL CORPORATION OF DISTRICT KOLKATA OF STATE WEST BENGAL, INDIA.

NAME : AARADHYA ROY GENDER : FEMALE

DATE OF BIRTH : 02/02/2021 PLACE OF BIRTH : CHITTARANJAN SEVA SADAN COLLEGE


OF OBS GYNAE & CHILD HEALTH,
KOLKATA MUNICIPAL CORPORATION,
KOLKATA, WEST BENGAL

NAME OF MOTHER : PRIYA KUMAR ROY NAME OF FATHER : ABHISHEK KUMAR ROY

MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -

PRESENT ADDRESS OF MOTHER HOUSENO:- 31A SATISH MUKHERJEE ROAD,STREET/LANE:- P.S- TOLLYGUNGE,LOCALITY:-
AT THE TIME BIRTH OF THE TOLLYGUNGE,VILLAGE/TOWN:- KOLKATA,KOLKATA MUNICIPAL CORPORATION MUNICIPALITY,DIST:-
CHILD : KOLKATA,WEST BENGAL-700026

PERMANENT ADDRESS OF HOUSENO:- 31A SATISH MUKHERJEE ROAD,STREET/LANE:- P.S- TOLLYGUNGE,LOCALITY:-


MOTHER : TOLLYGUNGE,VILLAGE/TOWN:- KOLKATA,KOLKATA MUNICIPAL CORPORATION MUNICIPALITY,DIST:-
KOLKATA,WEST BENGAL-700026

CERTIFICATE NO : B-2021: 19-90173- DATE OF REGISTRATION : 02/02/2021


005046

S-UHID : 75862848567877 REMARKS (IF ANY) :

DATE OF ISSUE : 29/07/2021 ISSUING AUTHORITY :

UPDATED ON : 2022-08-10 12:16:29

Signature Not Verified


Digitally Signed.
Name: PARTHA PRATIM ROY
Date: 14-Jan-2023 14:46:21

REGISTRAR (BIRTH & DEATH)


CHITTARANJAN SEVA SADAN
COLLEGE OF OBS GYNAE & CHILD
HEALTH

"THIS IS A COMPUTER GENERATED CERTIFICATE."


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

"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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