Form-5

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

GRAM PANCHAYAT JADUPUR-I

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR GRAM PANCHAYAT JADUPUR-I OF BLOCK/MUNICIPALITY ENGLISH BAZAR OF DISTRICT MALDA OF STATE
WEST BENGAL, INDIA.

NAME : SRISTI RISHI GENDER : FEMALE

DATE OF BIRTH : 13/03/2023 PLACE OF BIRTH : MALDA EDEN NURSING HOME, ENGLISH
BAZAR, MALDA, JADUPUR-I, WEST
BENGAL

NAME OF MOTHER : SHOVA CHOWHAN NAME OF FATHER : NISHIDEV RISHI

RISHI

MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : AADHAAR- XXXXXXXX0766

XXXXXXXX0887

PRESENT ADDRESS OF MOTHER STREET/LANE:- SARKARPARA,LOCALITY:- GAZOLE,VILLAGE/TOWN:- GAJOL,GAZOLE BLOCK,DIST:-

AT THE TIME BIRTH OF THE MALDA,WEST BENGAL-732124
CHILD :

PERMANENT ADDRESS OF STREET/LANE:- SARKARPARA,LOCALITY:- GAZOLE,VILLAGE/TOWN:- GAJOL,GAZOLE BLOCK,DIST:-

MOTHER : MALDA,WEST BENGAL-732124

CERTIFICATE NO : B/2023/334659 DATE OF REGISTRATION : 20/03/2023

S-UHID : 68738373598654 REMARKS (IF ANY) :

DATE OF ISSUE : 21/03/2023 ISSUING AUTHORITY :

UPDATED ON : 2023-03-20 19:39:41

Signature Not Verified

Digitally Signed.
Name: AYESHA YASMIN
Date: 21-Mar-2023 16:49:06

SUB-REGISTRAR (BIRTH & DEATH)

GRAM PANCHAYAT JADUPUR-I

"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

"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "