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सं.

1 हरयाणा सरकार प-5


NO. 1 GOVERNMENT OF HARYANA FORM-5
वाय सेवाएं वभाग
DEPARTMENT OF HEALTH SERVICES
ाइमर हेथ सटर सहोल
PRIMARY HEALTH CENTRE SIHOL

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा हरयाणा 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 HARYANA 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 ाइमर हेथ सटर सहोल तहसील पलवल िजला पलवल राय/संघ देश
हरयाणा, 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
PRIMARY HEALTH CENTRE SIHOL OF TAHSIL/BLOCK PALWAL OF DISTRICT PALWAL OF STATE/UNION TERRITORY HARYANA, INDIA.

नाम / NAME: TAIMUR ALI लं ग / SEX: / MALE

जम तथ / DATE OF BIRTH: जम थान/ PLACE OF BIRTH:


01-01-2017
FIRST-JANUARY-TWO-THOUSANDS SEVENTEEN

VILL BIJOPUR DHAUJ FARIDABAD


HARYANA, 121102

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


SAJIDA NAVED KHAN

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 OF BIRTH OF माता-पता के थायी पता/ PERMANENT ADDRESS OF
THE CHILD: PARENTS:

VILL BIJOPUR DHAUJ


HARYANA- 121004 BIJOPUR DHAUJ ,
HARYANA- 121004

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


B-2017: 6-00540-004326 21-01-2017

टपणी / REMARKS (IF ANY):


OK

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
21-01-2017
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाइमर हेथ सटर सहोल
PRIMARY HEALTH CENTRE SIHOL

UPDATED ON :
21-01-2017 13:03:29

"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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