Form-5

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

MUNICIPALITY TARAKESWAR

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 MUNICIPALITY TARAKESWAR OF BLOCK/MUNICIPALITY MUNICIPALITY TARAKESWAR OF DISTRICT
HOOGHLY OF STATE WEST BENGAL, INDIA.

NAME : ARSHIV GHOSH GENDER : MALE

DATE OF BIRTH : 23/01/2024 PLACE OF BIRTH : BADAL CHANDRA DAS MEMORIAL

MEDICAL COMPLEX, MUNICIPALITY
TARAKESWAR, HOOGHLY, WEST
BENGAL

NAME OF MOTHER : MOUMITA GHOSH NAME OF FATHER : BROJOGOPAL GHOSH

MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : AADHAAR- XXXXXXXX2839

XXXXXXXX7051

PRESENT ADDRESS OF MOTHER STREET/LANE:- VILL.- DEORAH,LOCALITY:- P.O.- ROUTHPUR,VILLAGE/TOWN:- DEORA,DHANIAKHALI

AT THE TIME BIRTH OF THE BLOCK,DIST:- HOOGHLY,WEST BENGAL-712402
CHILD :

PERMANENT ADDRESS OF STREET/LANE:- VILL.- DEORAH,LOCALITY:- P.O.- ROUTHPUR,VILLAGE/TOWN:- DEORA,DHANIAKHALI

MOTHER : BLOCK,DIST:- HOOGHLY,WEST BENGAL-712402

CERTIFICATE NO : B/2024/0157972 DATE OF REGISTRATION : 29/01/2024

S-UHID : 67325598636001 REMARKS (IF ANY) :

DATE OF ISSUE : 29/01/2024 UDIN : ----

UPDATED ON : 2024-01-27 10:42:45 ISSUING AUTHORITY :

Signature Not Verified

Digitally Signed.
Name: UTTAM KUNDU
Date: 15-Apr-2024 11:19:53

REGISTRAR (BIRTH & DEATH)

MUNICIPALITY TARAKESWAR

"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"