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NO. 1 GOVERNMENT OF WEST BENGAL FORM-5

রলেবRTুলNT ৃশ HলবLTH SলRVICলS

MUNICIPALITY NABADWIP

BIRTH CERTIFICATE

( - / ও000 - / | )
(ISSUED UNDER
SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL REGISTRATION OF BIRTHS &
DEATHS RULES 2000)

ং ং ং |
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE
REGISTER FOR MUNICIPALITY NABADWIP OF TAHSIL/BLOCK NABADWIP OF DISTRICT NADIA OF STATE/UNION TERRITORY WEST BENGAL,
INDIA.

/ NAME: PARVEJ MOSAROF / SEX: MALE

/ PLACE OF BIRTH:
/ DATE OF BIRTH: RAMCHANDRA PUR , SADAR
15-06-2001 NASHIPUR , LALGOLA ,
FIFTEEN-JUNE-TWO THOUSAND ONE MURSHIDABAD WEST
BENGAL-742148
/NAME OF MOTHER: / NAME OF FATHER:
SABINA BIBI YEADUR RAHAMAN

/MOTHER'S AADHAAR NO: /FATHER'S AADHAAR NO:

XXXXXXXX5260

- / ADDRESS OF PARENTS AT THE TIME OF BIRTH - / PERMANENT ADDRESS OF PARENTS:

OF THE CHILD:
RAMCHANDRA PUR , SADAR NASHIPUR , LALGOLA , MURSHIDABAD RAMCHANDRA PUR , SADAR NASHIPUR , LALGOLA
WEST BENGAL-742148
, MURSHIDABAD WEST BENGAL-742148

/ REGISTRATION NUMBER: / DATE OF REGISTRATION:

B-2021: 19-90065-001481 27-06-2001

/ REMARKS (IF ANY):

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/ DATE OF ISSUE: /ISSUING AUTHORITY :

05-11-2021
( )
REGISTRAR (BIRTH & DEATH)

SADAR NASHIPUR GRAM PANCHAYAT

UPDATED ON :
05-11-2018 11:50:02

"THIS IS A COMPUTER GENERATED CERTIFICATE. "

" 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".

" - ENSURE
" / REGISTRATION OF EVERY BIRTH AND DEATH "