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సంఖ 1 ఆంధ పే పభుతము ారం-5

NO. 1 GOVERNMENT OF ANDHRA PRADESH FORM-5


ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

MUNICIPAL CORPORATION SRIKAKULAM

జనన ధృవ పతము


BIRTH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION
OF BIRTHS & DEATHS RULES 1999)

రత ేశము, ఆంధపే ాషము ాళం లా ాళం మండలము (ాక పేశము) జనన మరణ ిషేరులో జనాి సంబంింన అసలు ిారు నుంి,
ింి సమారము సుొనబినద ధృకించడైని.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
MUNICIPAL CORPORATION SRIKAKULAM OF TAHSIL/BLOCK SRIKAKULAM OF DISTRICT SRIKAKULAM OF STATE/UNION TERRITORY ANDHRA
PRADESH, INDIA.

రు / NAME: PADALA NIHASWI ంగము / SEX: సీ FEMALE

పటిన ేీ / DATE OF BIRTH:


పటిన సలము/ PLACE OF BIRTH:
19-10-2020
DWARAKAMAYI HOSPITAL
NINETEENTH-OCTOBER-TWO THOUSAND TWENTY

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER:


VAKADA SWATHI PADALA SUDHEER KUMAR

ఆా సంఖ / MOTHER'S AADHAAR NO: ఆా సంఖ / FATHER'S AADHAAR NO:
XXXXXXXX2095
XXXXXXXX1892

డ జంనపడు తలిదండులు రుామ / ADDRESS OF PARENTS AT THE TIME OF తలిదండులు క ిరాసప రుామ/ PERMANENT
BIRTH OF THE CHILD: ADDRESS OF PARENTS:
PEDDA LAXMI PURAM,
GANGARAJAPURAM, , MELIAPUTTI, SRIKAKULAM, ANDHRA PRADESH- 532216 PEDDA LAXMI PURAM,
GANGARAJAPURAM, MELIAPUTTI, SRIKAKULAM,
ANDHRA PRADESH- 532216

నదు సంఖ / REGISTRATION NUMBER: నదు ేీ / DATE OF REGISTRATION:


B-2020: 28-90005-006176 22-10-2020

ేాంశములు / REMARKS (IF ANY):


---

ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY :
22-10-2020
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)

MUNICIPAL CORPORATION SRIKAKULAM

UPDATED ON :
22-10-2020 00:00:00

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES".

" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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