.

1 -ख
NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5

मयPपTMयNT Oर MयमICपL पNम HयपLTH

NAGAR NIGAM LUCKNOW

-
BIRTH CERTIFICATE

( , 1ज6ज 12 आ 17 , 2002 8आ13

(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)

आ
,
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
NAGAR NIGAM LUCKNOW OF TAHSIL/BLOCK LUCKNOW OF DISTRICT LUCKNOW OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

/ NAME: MOHD ZAID KHAN / SEX: / MALE

/ DATE OF BIRTH: / PLACE OF BIRTH:

21-09-2006 B-64 RAJEEV NAGAR KANCHANA BEHARI , MARG KALYANPUR
TWENTY ONE -NOVEMBER -TWO THOUSAND SIX VIKAS NAGAR ,
LUCKNOW,LUCKNOW, LUCKNOW,
UTTAR PRADESH

आNAME OF MOTHER: / NAME OF FATHER:

पYयSHप KHपN ZUBAIR KHAN

- / ADDRESS OF PARENTS AT THE TIME - / PERMANENT ADDRESS OF PARENTS:

OF BIRTH OF THE CHILD:
B-64 RAJEEV NAGAR KANCHANA BEHARI , MARG KALYANPUR VIKAS NAGAR , B-64 RAJEEV NAGAR KANCHANA BEHARI, MARG KALYANPUR
LUCKNOW, , LUCKNOW, LUCKNOW, UTTAR PRADESH VIKAS NAGAR,
LUCKNOW, LUCKNOW, LUCKNOW,
UTTAR PRADESH

/ REGISTRATION NUMBER: / DATE OF REGISTRATION:

B-2018: 9-90321-069050 25-10-2018

/ REMARKS (IF ANY):

2क1कखआजख

/ DATE OF ISSUE: आ
ISSUING AUTHORITY :
25-10-2018
( )
REGISTRAR (BIRTH & DEATH)

NAGAR NIGAM LUCKNOW

UPDATED ON :
25-10-2018 14:55:57

"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".

" " आ
ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "