सं.

1 बहार सरकार प-5

NO. 1 GOVERNMENT OF BIHAR FORM-5
योजना और वकास वभाग
DEPARTMENT OF PLANNING AND DEVELOPMENT
कंकडबाग अंचल पटना नगर नगम
KANKARBAGH CIRCLE, PATNA MUNICIPAL CORPORATION

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा बहार जम मृयु रिजकरण नयम, 1999 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 BIHAR REGISTRATION OF
BIRTHS & DEATHS RULES 1999)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क कंकडबाग अंचल पटना नगर नगम तहसील पटना सदर िजला
पटना राय/संघ देश बहार, 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 KANKARBAGH CIRCLE, PATNA MUNICIPAL CORPORATION OF TAHSIL/BLOCK PATNA SADAR OF DISTRICT PATNA OF STATE/UNION
TERRITORY BIHAR, INDIA.

नाम / NAME: MOHTASHIM AMIN KHAN लंग / SEX: पुरष / MALE

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

13-05-2018 KANKARBAGH WARD NO.-34 PMC, LOHIYA NAGAR,
THIRTEENTH-MAY-TWO THOUSAND EIGHTEEN PATNA,PATNA SADAR, PATNA,
BIHAR, 800020

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

BILQUIS TABASSUM MD AMINUDDIN KHAN

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX6704

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
NAUGHARWA , POST.-MAHENDRU , NAUGHARWA, POST.-MAHENDRU,
PS.-SULTANGANJ, PATNA, , PATNA SADAR, PATNA, BIHAR- 800006 PS.-SULTANGANJ, PATNA, PATNA SADAR, PATNA,
BIHAR- 800006

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

B-2024: 10-98659-002481 30-01-2024

टपणी / REMARKS (IF ANY):

ON THE BASIS OF BDO. PATNA LT NO.-4555/20-01-24. IF FOUND ERRONEOUS OR
FRAUDULENTLY MADE WILL BE CANCELLED.

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
30-01-2024
उप-रिजार (जम एवं मृयु)
SUB-REGISTRAR (BIRTH & DEATH)
कंकडबाग अंचल पटना नगर नगम
KANKARBAGH CIRCLE, PATNA MUNICIPAL
CORPORATION

UPDATED ON :
30-01-2024 02:55:42

"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 "