Form 5

తెలంగాణ ప్రభుత్వము
GOVERNMENT OF TELANGANA
వైద్య ఆరోగ్య శాఖ
HEALTH, MEDICAL & FAMILY WELFARE DEPARTMENT

జనన ధృవ పత్రము

BIRTH CERTIFICATE

(Issued under Section 12/17 of the Registration of Births and Deaths of the Registration of Births and Deaths Rules 1999)
This is to certify that the following information has been taken from the original record of birth, which is the register for of NAGARAM
MUNICIPALITY Telangana State, India

Name :
Sex : Male
Date of Birth : 16/10/2023
Place of Birth : JANANI HOSPITAL
Name of Mother : PELLURI LAKSHMI TRIVENI
Name of the Father : PELLURI PRASAD

Address of the parents at the time of Birth of Child : Permanent Address of parents :
PLOT NO:7,ROAD NO:1,SNEHAPURI
PLOT NO:7,ROAD NO:1,SNEHAPURI
COLONY DAMMAIGUDA,MEDCHAL
COLONY DAMMAIGUDA,MEDCHAL MALKAJIGIRI
MALKAJIGIRI DIST TELANGANA
DIST TELANGANA 500083
500083

Registration No : 482
Date of Registration : 19/10/2023
Date of Issue : 19/10/2023
Remarks :

Registrar of Births & Deaths

NAGARAM MUNICIPALITY
Designation : MUNICIPAL COMMISSIONER

Note: The information is as provided by Hospital authorities and does not require physical signature.And this certificate can verified at
http://ubd.telangana.gov.in by furnishing the application number mentioned in the Certificate.