Key No.

B0080573-2010159
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
]©mb¯v hIp¸v
DEPARTMENT OF PANCHAYAT
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv ASnamen {Kma ]©mb¯v
Name of Local Government issuing certificate Adimaly Grama Panchayat
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse CSp¡n Pnñbnse tZhnIpfw Xmeq¡nse ASnamen {Kma ]©mb¯v
þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
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) Adimaly Grama Panchayat of Taluk Devikulam of District Idukki of State Kerala.
---t]cv/ Name : t]cv cPnÌÀ sNbvXn«nñ / Name Not Registered
---B¬/s]¬/ Sex B¬/ Male
:
---P\\ XobXn/ Date of Birth : 14/10/2020
FOURTEEN/OCTOBER/TWO THOUSAND TWENTY
---P\\ Øew/ Place of Birth :
Xmeq¡v Bip]{Xn ASnamen, ASnamen/

Taluk Hospital Adimali, Adimali

---amXmhnsâ t]cv / Name of Mother
---]nXmhnsâ t]cv/ Name of Father
Ip«nbpsS P\\ kab¯v
amXm]nXm¡fpsS taðhnemkw
enän ]oäÀ / Litty Peter
:
: tPm¬k¬ ]n sP / Johnson P J
: ]p¯³]pcbv¡ð, Iq¼³]md ]n H, Iq¼³]md, CSp¡n, tIcfw, C³Uy

Address of the parents at the time of : Puthenpurackal, Koompanpara P O, Koompanpara, Idukki, Kerala, India
birth of the child
amXm]nXm¡fpsS Øncamb : ]p¯³]pcbv¡ð, Iq¼³]md ]n H, Iq¼³]md, CSp¡n, tIcfw, C³Uy
taðhnemkw

Permanent address of parents : Puthenpurackal, Koompanpara P O, Koompanpara, Idukki, Kerala, India

cPnkvt{Sj³ \¼À/ : 1663/2020 cPnkvt{Sj³ XobXn/ : 16/10/2020

Registration Number Date of Registration
---A`n{]mb¡pdn¸v/ Remarks (if any) :

---\ðIp¶ XobXn/ Date of Issue : 31/03/2021 (14:37) Last Updated on 19/10/2020 (16:10)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Adimaly Grama Panchayat

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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