1 GOVERNMENT OF ANDHRA PRADESH 2^,653^ $$30 ๙๖ ☆fcooa ^Fdo-5

DEPARTI&NT OF HEALTH. MEDICAL AND FAMILY WELFARE FORM-5

GVMC ZONE 4

2A?5?5 CSJSS
BIRTH CERTIFICATE

๐ 1969,12/17 eso^S ^S2>-§ 55^6 sSidra 1999, s/13

(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)

ej’rfsS GVMC ZONE 4 (^^๙

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR GVMC ZONE 4 OF TAHSIL/BLOCK
VISAKHAPATNAM URBAN OF DISTRICT VISAKHAPATNAM OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

๖* / NAME: AKANSH MAHARANA

3b / DATE OF BIRTH:

TWENTY-SEVENTH-AUGUST-TWO THOUSAND TWENTY ONE

/ NAME OF FATHER: SUDHANSU

2 ๖^ ^๐^/ PLACE OF BIRTH:
MOHARANA
AKARSH0HOSPITALS VISAKHAPATNAM
/ REMARKS (IF ANY):

^๖ 6 / NAME OF MOTHER:
USHARANI MAHARANA

escyg / MOTHER'S AADHAAR NO: esqpS ^>0^ / FATHER'S AADHAAR NO:

๙^ 3&)I DATE OF ISSUE: XXXXXXXX9490 ^5 ๐๙๙ 0 / ISSUING AUTHORITY ：
18-09-2021
XXXXXXXX8746

๙^๐(๘ 3 ๐ 3 / ADDRESS OF PARENTS AT THE TIME OF ๙REGISTRAR (BIRTH

0 ๘ 0(๘ 3 ๐ 3 ๐๖ 3 ๙^ & DEATH)SdxO’SSy/ PERMANENT
BIRTH OF THE CHILD: ADDRESS OF PARENTS:
NEAR OLD PETROL PUMP, GVMC ZONE 4
BHEJAPUT, BHOIGUDA,, KORAPUT , KORAPUT, ODISHA- 763008 NEAR OLD PETROL PUMP,
BHEJAPUT, BHOIGUDA, KORAPUT, KORAPUT,
ODISHA- 763008
UPDATED ON ：
31-08-2021
6X ๖ 00:00:00
/ REGISTRATION NUMBER: 3 ๖/DATE OF REGISTRATION:
B-2021: 28-90224-002199 31-08-2021

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

’ IgSS 2d：6；555». 21 S’aa-oS' 3di>0&- / ENSURE KE(ilSTK,\TION OF EVERY BIRTH AND DEATH
1