MILITARY HOSPITAL KHADKI, PUNE - 20

PROVISIONAL BIRTH
CERTIFICATE
This is to certify that baby (Male) was born to
Smt chbalculi Aot Age 20 ur wife of No. IS868 49
Rank Name A Unit Ac Ba
on at 058
h_hrs In this hospital. BEen tr
Birth weight Q310 |cG
Birth Regd No 06|2la as. (Signature of the nursingoffç conductingthe case)
Date: (PARVEZ MULLANI)
LðGol/AMC
Gd spl (Obs &3yn)
(Signature of the MedËcal Officer)

Note : This birth certificate is not legally valid, obtain the proper birth certificate from Cantonment Board Ofice, Khadki,
Pune-03.
 Fom No. 1 Form No. 1
BIRTH REPORT BIRTH REPORT
(See Rule No. 5) Statistical Information
Legal Information This part to be dctached and sent for
This part to be added to the Birth Reglster statistical processlng
To be flled by the Informant To be flled by the informanr To be flled by the Informant

1. Date of Blrth:.4.9...22A... 2. Sex:MMA.£10. Town or village of Residence of the Mother: If he case of multiple births, In a separate fom for each child and write
(Enter the exad day, month and year the chlld was bomeg.1-1-2000) lives. Thls can ba difterent from the
(Place where (he mother usually twin blrth or Triple birth elc. as the case may be In the remarks column in
3. Name ofthechild, Many:. place where the Birh ocCurred. The house address ls not requlred to the box belowleft.
be entered)
4. Fullname of the father: MBNE..AMMII.BATE. (a) NameofTownvillage:.m..ARNAL Io be flled by the infonmans
(Ful name as capltal leter) NDPA 16. Age of themother (In completed years)
5. Full name of the mother :.HAASHI.A.ML.I.. (b) Is lla town or vllage:(Tlckthe approprlale entrvbalow)
1. Town 2.Jllaga
At the lime of marrage:. ********s****
2.9.S.
(if mariage more than once, age at first marriage may be entered)
(Full name as capBal leter) MAN
6. Address of Parents at the tlme of birth of the chlld :. (c) Name of Tahasit: MIRAT 17. Age of he mother (In completed years)
Attho Ume of thls birh:
(d) Nameof Dlstrict:.SAAG
NGa.D.sAz.a.......mH) 18. Numberof chldrenbom alve to the mothar so far Including thls child
(e) Name of Slate :....MH. et*******. * . . . . G . 2 .
4Wo03
7. Permanent address of parents. Pin 19. Type of attentlon at dellvery: C NORnAL)
A...A..Bd..s..Ma...f..n 11. 1.Rellglon:
Blndu
(Tlck the approprlate eniry3. below)
2. Musllm ChrisUan (TIck the approprlate enty below
4. Institutlonal-Government
D..e.D.....f...4.6,r
8. Place of blrth:(Tck the appropriale entry 1or2 belowend ghven the 4. Anyolherrellglon :. HINDU 2. Institutlonal-Prtvate of Non-Government
(wdte name of the rellglon) 3. Doctor, Nurse or Tralned mldwife
name of the Hospltal / Institulon or the address of the house where 4. Traditlonal BirthAftendent
the birth took place, glven localon) 12, Father's lovel ofeducatlon.
(f no occupalon wrile 'NI")
SC. 5. Relatves or others
1. Hospltal/nsilulon: MH Khadkl, Name &Address: Clo. 58APO 20. Methgd of Dlvery: (Tick the appropriate enty beow)
Mother's level of educatlon :.....s.A.T.
9. Informant's name:.MANE..I.LAJEND 13. (fno ANatural 2. Caesarean 3. Forceps/Vacuum
occupalion write Nl)
Address:Sameasaboye para-7 21. Birth Welght (In kgs.) (f avallable):
(Ator compleling all columns 1lo 20, Inlomant wl put dale and slgnaturo here.) 14. Father's occupatlon :.
(Ifno occupalon write 'Nil) 22. Duration of pragnancy(in woeks)...g.S.SSdSJ..
15. Mother's occupatlon:.
(lfno occupalion wrile 'Ni) HovSE WIFE (PARVEZ MðLL¬NI)
Slgnature of the Informant
Date:
(s\dhorObsdyhlcologtst)
yn)
To be filled by the Reglstrar To be flled by the Reglstrar To be flled by tie
Reglstralon No:. Reglstration Dale:. Place Name Code No. Registration No: Registralion Date:..
Reglstraion Unlt: Date of Blrh:
Dlstrict Age ...
TownWillage:. District:
Years / Months /Days/Hours
Remarks: (ifany). Tahsll
Sex :1. Mal 2. Female
Name, Seal &slgnature of the the Registrar Town /Vllage Place of Birth :1. Hospital / Institution 2. Hous
3. Other place
Dale of lssuance Address of Issulng Registralon
Unit
of cerificate authority Name, Seal &signature of the Regstrar
 GOVERNUENY OF NDIA

Amil Rajendra Mane

PH TÚ Year of Birth: 199:
T/Male

5457 9601 9620

UNIQUE IDENTIFICATION AUTHORITY OF INDIA

Addrcss 98 mane g. ckanath

chouk, Karnal, Karnal, Sang.,
416416 Maharashtra, 4 164 16

a www.
1947 helpguldal.gov In www.uldal.gov.in PO. Box No. 1947.
1800 180 1947 Bengaluru-560 001
 Govenment of Irdia

Chhakul Amit Mane

A a/ DOB: 22/111995
H IFEMALE

7355 1646 5033

Unique identcaton Autcrty of nga

Address:
VEER EKNATHCHOWK A.
GALI, KARNAL, Karnal. Sang:
EZTZ- 4 16416 Maharashtra - 416416

7355 1646 5033