No-40954 Form 5

Translation from Hindi to English

GOVERNMENT OF BIHAR
(DEPARTMENT OF PLANNING AND DEVELOPMENT)
DIRECTORATE OF ECONOMICS AND STATISTICS
BIRTH CERTIFICATE

(Issued under section 12/17 of the registration of Births and Death Act, 1969 and Rule 8/13 of the Bihar
Registration of Births and Deaths Rules, 1999)

This is to certify that the following information has been taken from the original record of birth which
is the register for (local area/local body) PATNA of Tahsil Patna of District Patna of State: Bihar

Name:- ANSH ARYA Sex:-MALE

Date of Birth:-10/04/2011 Place of Birth:-PATNA
Name of Mother:-Sarita Triveni Kumari
Name of Father :- Abhay Satyaprakash Arya

Address of parents at the time of Birth of the child Permanent address of parents
Indrapuri Road no 6, Building no 86
Patliputra Patna

Registration No ... 43562 Date of Registration .... 09/24/2013

Remarks (if any) …….

Date of Issue ... 09/24/2013 Signature of the issuing authority

Address of the issuing authority

REGISTRAR
BIRTH AND DEATH
Patna Muncipal Corporation
PATNA