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DECLARATION

I hereby declare that my male child born on 05th January, 2012 at C.W.C. 11 BEGUM SAHIB STREET, ROYAPETTAH, CHENNAI-600 014 has been named as

S. MOHAMMAD SHAMEEM. The name of the child given here is correct,


complete and final. I am fully aware that the name once registered in the Birth Register cannot be changed at any cost.

Name of the Father: M. SULAIMAN Name of the Mother : S. BARAKATH NISHA


Signature of Parent

DECLARATION
I hereby declare that my male child born on 05th January, 2012 at C.W.C. 11 BEGUM SAHIB STREET, ROYAPETTAH, CHENNAI-600 014 has been named as

S. MOHAMMAD SHAMEEM. The name of the child given here is correct,


complete and final. I am fully aware that the name once registered in the Birth Register cannot be changed at any cost.

Name of the Father: M. SULAIMAN Name of the Mother : S. BARAKATH NISHA


Signature of Parent

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