सं.

1 बहार सरकार प-5

NO. 1 GOVERNMENT OF BIHAR FORM-5
योजना और वकास वभाग
DEPARTMENT OF PLANNING AND DEVELOPMENT
सदर अपताल कशनगंज
SADAR HOSPITAL KISHANGANJ

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 सदर अपताल कशनगंज तहसील कशनगंज िजला कशनगंज
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 SADAR HOSPITAL KISHANGANJ OF TAHSIL/BLOCK KISHANGANJ OF DISTRICT KISHANGANJ OF STATE/UNION TERRITORY BIHAR,
INDIA.

नाम / NAME: SAIF SHAD लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
24-08-2021
SADAR HOSPITAL KISHANGANJ
TWENTY-FOURTH-AUGUST-TWO THOUSAND TWENTY ONE

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

SAYENSHA NOORSHAD ALAM

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX1753
XXXXXXXX4121

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF
BIRTH OF THE CHILD: PARENTS:
DEONA ,
IKARCHALA, , GOALPOKHAR - I, UTTAR DINAJPUR, WEST BENGAL- 733208 DEONA,
IKARCHALA, GOALPOKHAR - I, UTTAR DINAJPUR,
WEST BENGAL- 733208

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

B-2021: 10-90278-003782 10-09-2021

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
21-11-2023
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
सदर अपताल कशनगंज
SADAR HOSPITAL KISHANGANJ

UPDATED ON :
21-11-2023 07:38:44

"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 "