G189 V

Schedule XXX-Form No.8 FORM No.: 7

(See Rule-8)

GOVERNMENT OF ORISSA No.: 11CYi /PH/Vs

DEPARTMENT OF HEALTH AND FAMILY WELFARE
Date./04/OP
CERTIFICATE OFBIRTH
Issued under Section 17 of the Registration of Births & Deaths Acts, 1969 and Rule of Orissa
Births and deaths, Rule 2001

This is to certify that the fahorring information has been taken from the original record of Birth which
is in the register for... ***o*.*.** of BHUBANESWAR MUNICIPAL CORPORATION,
DistrictKhurda, Orissa.

BNA YAKA DEBIDUTTA BEHERA MAHESWAR BEMERA

Name . Name of the Father .... .
MALE SASMTA BEHERA C
Sex °**°°
***** Name of the Mother
..
10 Hovember.2004 DAKHANASAHI
Date of Birth . ***** Permanent Address..... ..
MATERNITY CARE HOSPITAL,BHUBANESWAR SARASWATIPUR, BALANGA
Place of Birth .
14589/2004 DIST-PURI.ORISA
Registration No. ***°°*°°

06/12/2004
Date of Registration ...

Signature of fssuig Authoríty

Registrar, Births & Deaths
Date
25.072008 &City Health Officer
BHuádesvar Municipal Corporation

iaska ayatred Y NICOSLA, Ftbararar, Ories