dos 1 rCo-s

NO. 1 GOVERNMENT oF ANDHRA PRADESH FORM-5

DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE
AREA HOSPITAL KADIRI

BIRTH CERTIFICATE

(353Ba 3P) Se o1969, 12/17 Japá) S5oá), esoE SSdca s ) Josew 1999, 8/13 5o raibc33)
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND
REGISTRATION OF BIRTHS & DEATHS RULES 1999) RULE 8/13 OF THE ANDHRA PRADZSI

THIS IS TO CERTIFY TH¤T THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE
FOR AREA HOSPITAL KADIRI OF TAHSIL/BLOCK KADIRI OF DISTRICT SRI ORIGINAL RECORD OF BIRTH WHICH IS THE REGIS SEI
SATHYA SAI OF STATE/UNION TERRITORY ANDHRA PRADESH, INDI..

a/NAME: POLA JEEVAN KUMAR Oosá/ SEX: 3os MALE

J s Ib |DATE OF BIRTH:
21-01-2023 es s /PLACE OF BIRTH:
TWENTY-FIRST-JANUARY-TWO THOUSAND TWENTY THREE AREA HÕSPITAL KADIRI
d / NAME OF MOTHER: boÐo /NAME OF FATHER:
P. SANDYARANI
P. SUDHARSHAN
es6 os /MOTHER'S AADHAAR NO: eSQ o s / FATHER'S AADHAAR NO:

Da oo@d d do
BIRTH OF THE CHILD:
ddráP |ADDRESS OF PARENTS AT THE TIME OF
ADDRESS OF PARENTS:
A.KOTHAPALLI, AMADAGUR, , AMADAGUR, SRI SATHYA SAI, ANDHRA PRADESH
A.KOTHAPALLI, AMADAGUR, AMADAGUR, SRI SATIYA : AI,
ANDHRAPRADESH
33rá Sos /REGISTRATION NUMBER: S3rc) J / DATE OF REGISTRATION:
B-2023: 28-15264-000068 21-01-2023

JroSwes/REMARKS (IF ANY):

a BNs D/ DATE OF ISSUE: 70 S5 SE soso / ISSUING AUTHORIrY:

26-04-2023

REGISTRAR (BIRTH &DEATH)

AREA HOSPITAL KADIRI

UPDATED ON:
21-01-2023 18:00:11

wTHIS IS A
COMPUTER GENERATED CERTIF1CATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUINGAUTHORITY"
" THEGOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS AVALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES".
"Bo B3S), b8Sdoá dsoG 21ooî Sras Baboa/ ENSURE REGSTRATION OFEVFRY BIRTHAND DEATII"