मांक 1 महारा शासन फॉम-5

NO. 1 GOVERNMENT OF MAHARASHTRA FORM-5

आरोय वभाग
DEPARTMENT OF HEALTH

MUNICIPALITY JALNA

जम माणप
BIRTH CERTIFICATE

जम व मृयु नदणी अधनयम, 1969 या कलम 12/17 आिण महारा जम आिण मृयु नदणी नयम, 2000 चे नयम 8/13 अवये देयात आले आहे. (ISSUED
UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MAHARASHTRA REGISTRATION OF BIRTHS &
DEATHS RULES 2000)

मािणत करयात येत आहे क, खालल माहती जमाया मूळ अभलेखाया नदवहतून घेयात आल आहे , जी क महानगरपालका जालना , तालुका जालना ,
िजहा जालना , महारा राया, भारत या नदवहत उलेख आहे.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
MUNICIPALITY JALNA OF TAHSIL/BLOCK JALNA OF DISTRICT JALNA OF STATE/UNION TERRITORY MAHARASHTRA, INDIA.

नाव / NAME: MAHEK GAURAV RAJPUT / महेक गौरव राजपुत लंग / SEX: महला / FEMALE

जम तारख / DATE OF BIRTH: जम ठकाण/ PLACE OF BIRTH:

08-07-2016 DIST.WOMEN & CHILD HOSPITAL JALNA/िजहा महला व बाल रणालय
EIGHTH-JULY-TWO THOUSAND SIXTEEN जालना

आईचे पूण नाव / NAME OF MOTHER: वडलांचे पूण नाव / NAME OF FATHER:
RAJSHRI GAURAV RAJPUT / राजी गौरव राजपुत GAURAV RAJPUT / गौरव राजपुत

आधार मांक / MOTHER'S AADHAAR NO: आधार मांक / FATHER'S AADHAAR NO:
XXXXXXXX2890
XXXXXXXX5522

बाळाया जमायावेळी आई-वडलांचा पा / ADDRESS OF PARENTS AT THE TIME आई-वडलांचा कायमचा पा/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:

JALNA, JALNA, JALNA, JALNA, JALNA, JALNA,

MAHARASHTRA MAHARASHTRA

जालना (म ल), जालना, जालना, जालना (म ल), जालना, जालना,

महारा महारा

नदणी मांक / REGISTRATION NUMBER: नदणी ​दनांक / DATE OF REGISTRATION:

B-2017: 27-90121-009495 15-11-2017

शेरा / REMARKS (IF ANY):

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माणप दयाचा दनांक / DATE OF ISSUE: नगमत करणारे ाधकार / ISSUING AUTHORITY :
18-03-2019
रिजार (जम व मृयु)
REGISTRAR (BIRTH & DEATH)

MUNICIPALITY JALNA

UPDATED ON :
18-03-2019 12:39:03

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" 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 आिण मृयूची घटना नदयाची खाी करा " / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "