Key No.

B0060211-07122612
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
\KcImcy hIp¸v
DEPARTMENT OF URBAN AFFAIRS
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv at©cn ap\nkn¸menÁn
Name of Local Government issuing certificate Manjeri Municipality
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 ae¸pdw Pnñbnse Gd\mSv Xmeq¡nse at©cn ap\nkn¸menÁn 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) Manjeri Municipality of Taluk Ernad of District Malappuram of State Kerala.
---t]cv/ Name : apl½Zv ipssd^v .hn / MUHAMMED SHURAIF .V
---B¬/s]¬/ Sex B¬/ Male
:
---P\\ XobXn/ Date of Birth : 26/12/2007
TWENTY SIX/DECEMBER/TWO THOUSAND SEVEN
---P\\ Øew/ Place of Birth :
Pnñm Bip]{Xn at©cn, at©cn/

District Hospital Manjeri, Manjeri

---amXmhnsâ t]cv / Name of Mother
---]nXmhnsâ t]cv/ Name of Father
Ip«nbpsS P\\ kab¯v
amXm]nXm¡fpsS taðhnemkw
jd^o\. Fw / SHARAFEENA. M
:
: \u^ð jm¡nÀ. hn / NOUFAL SHAKIR. V
: hS¡m§c lukv,aª¸ä t]mÌv, ae¸pdw, tIcfw, C³Uy

Address of the parents at the time of : VADAKKANGARA HOUSE,MANJAPPATTA POST, Malappuram, Kerala, India
birth of the child
amXm]nXm¡fpsS Øncamb : hS¡m§c lukv,aª¸ä t]mÌv, ae¸pdw, tIcfw, C³Uy
taðhnemkw

Permanent address of parents : VADAKKANGARA HOUSE,MANJAPPATTA POST, Malappuram, Kerala, India

cPnkvt{Sj³ \¼À/ : 11566/2007 cPnkvt{Sj³ XobXn/ : 27/12/2007

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

---\ðIp¶ XobXn/ Date of Issue : 20/05/2022 (11:12) Last Updated on 02/06/2012 (16:58)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Manjeri Municipality

“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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