सं.

1 उर देश सरकार प-5

NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH

नगर नगम गािजयाबाद

NAGAR NIGAM GHAZIABAD

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002)

यह मािणत कया जाता है ननलिखत सुचना जम के मूल अभलेख से ल गई है जो क नगर नगम गािजयाबाद तहसील गािजयाबाद िजला गािजयाबाद
राय/संघ देश उर देश, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER
FOR NAGAR NIGAM GHAZIABAD OF TAHSIL/BLOCK GHAZIABAD OF DISTRICT GHAZIABAD OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

नाम / NAME: ADYUT SHARMA लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH: जम थान/ PLACE OF BIRTH:

27-10-2020 YASHODA SUPER SPECIALITY HOSPITAL KAUSHAMBI
TWENTY-SEVENTH-OCTOBER-TWO THOUSAND TWENTY GHAZIABAD

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:

NEHA KANOJIA SUBODH KUMAR SHARMA

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

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF
BIRTH OF THE CHILD: PARENTS:
B-1006, DRONAGIRI APPT.,, SEC-11, VASUNDHARA,
GHAZIABAD, , GHAZIABAD, GHAZIABAD, UTTAR PRADESH- 201012 B-1006, DRONAGIRI APPT.,, SEC-11, VASUNDHARA,
GHAZIABAD, GHAZIABAD, GHAZIABAD,
UTTAR PRADESH- 201012

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:

B-2020: 9-90103-022916 29-10-2020

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
05-11-2020
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नगर नगम गािजयाबाद
NAGAR NIGAM GHAZIABAD

UPDATED ON :
05-11-2020 13:13:30

"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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "