सं.

1 उर देश सरकार

NO. 1 GOVERNMENT OF UTTAR PRADESH
प-5
चकसा एवं वाय वभाग FORM-5
DEPARTMENT OF MEDICAL AND HEALTH
नगर नगम जोन ३ कानपूर नगर
NAGAR NIGAM ZONE 3 KANPUR NAGAR

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 सूचना जम के मूल अभलेख से ल गई है जो क नगर नगम जोन ३ कानपूर नगर तहसील कानपुर िजला कानपुर
नगर 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 ZONE 3 KANPUR NAGAR OF TAHSIL/BLOCK KANPUR OF DISTRICT KANPUR NAGAR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

नाम / NAME: ISHIKA लंग / SEX: महला / FEMALE

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

09-07-2023 GOPAL KRISHNA HOSPITAL ,
NINTH-JULY-TWO THOUSAND TWENTY THREE KANPUR,KANPUR , KANPUR NAGAR,
UTTAR PRADESH

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

SHILPI ABHIJEET DUBEY

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 माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
TIME OF BIRTH OF THE CHILD:
84/11 BLOCK NO-9 GOVIND NAGAR , 84/11 BLOCK NO-9 GOVIND NAGAR,
KANPUR, , KANPUR , KANPUR NAGAR, UTTAR PRADESH KANPUR, KANPUR , KANPUR NAGAR,
UTTAR PRADESH

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

B-2023: 9-93820-002260 03-11-2023

टपणी / REMARKS (IF ANY):

1488/2-11-23

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
26-12-2023
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नगर नगम जोन ३ कानपूर नगर
NAGAR NIGAM ZONE 3 KANPUR NAGAR

UPDATED ON :
26-12-2023 05:53:03

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