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NO.1 GOVERNMENT OF UTIAR PMDESH ErDt-5

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FORM.5
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DEPARTMENT OF MEDICAL AND HEALTH

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NAGAR NIGAM LUCKNOW ZONE 3 ffi
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BIRTH CERTIFICATE

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(ISSUED UNDER SECTION L2II7 OF THE REGISTMTION
OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTIAR PMDESH
OF BIRTHS & DEATHS RULES 2OO2) REGISTMTION

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THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN

FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER
FOR NAGAR NIGAM LUCKNOW ZONE 3 OF TAHSIUBLOCK LUCKNOW OF
DISTRICT LUCKNOW ON STATTruNTON TERRITORY UTIAR PRADESH, INDIA.

;II+r / NAME: PIHOO SINGH qforl

Firr / ssx' FEMALE

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10-01-201s
/ DATE oF BIRTH: wq Fqrd/ PI ACE OF BIRTH:
533/74-NAYA HANUlvl{\f MANDI& ALIGANJ,
TENTH-JANUARY-TWO THOUSAND FIFTEEN LUCKNOWLUCKNOW, LUCKNOW
UTTAR PMDESH
qTil ST AI+T / NAME OF MOTHER: lqm orErrT / NAME oF FATHER:
MAMTA SINGH MANVENDM SINGH
grerr i{t / MoTHER,S.q.eDHeRRNo: 3'TENT dTT / FATHER'SMDHAARNO:

sE+ t q-q * gaq qrdr-ftil 6T qiTT /ADDRESS oF pARENTs ATTHE TIME qf,-fufrT * VqTS KIT/ PERMANENTADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:

LUCKNOW,, LUCKNOW LUCKNOW UTIAR PMDESH LUCKNOW, LUCKNOW, LUCKNOW,

UTTAR PMDESH
Tifi-+Tor+icqr I nrctsrMTloN NUMBER: rififilr arfte I oarn oF REGISTMTToN:
B-2019: 9-91808-004825 12-12-2019
fteqft I REMARKS (rF ANy):
REHAN

wt 6-{+ fi ftlqlDATEoFrsSUE: orft o-c+ srf,T cTfYfiI / ISSUING AUTHoRITY:

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REGISTRAR & DE{TH)
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NAGAR NIGAM LUCKNOW ZONE 3

UPDATED ON:
1,2-12-2019 00:00:00

"THIS IS A COMPUTER GENEMTED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY'
. THE GOVT.
OF INDIA VIDE CIRCUI"AR NO, III2I2O1.4.VS(CRS) DATED 27.JULY.2O15 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DoCUMENT FoR ALL oFFicTAL PURPoSES,.

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