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FORM-5
NO. GOVERNMENT OF MAHARASHTRA
3T T DEPARTMENT OF HEALTH

MUNICIPAL. CORPORATION NASHIK PANCHAVATI ZONE

BIRTH CERTIFICATE

1SSUELD
UNDER SÉChoN 12/17 OF THE REGISTRATION OF AIRTHS &DEATHS ACT, 1969 AND kULE A/3OF THE MAHARASHTRAREGISTRATION OF RIRTIIS s DEATHS
2000)

THIS I S TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOP
ICIPAL CORPORATION NASHIK PANCHAVATI ZONE OF TAHSILBLOCK NASHIK OF DISTRICT NASHIK OF STATEnUNION TERRITORY MAHARASHTRA
MUNICI
INDIA

AT NAME MALHAR PRAKASH BAGUL fT1 | SEX: / MALE

FAR |DATE OF BIRTH: RfATU/ PLACE OF BIRTH:

21-05-2018 HOME, MAKHAMALABAD NASHIK/F r
NEW NINAD MA
TWENTY-FIRST-MAY-TWO THOUSAND EIGHTEEN
IE I NAME OF MOTHER: aís 4INAME OF FATHER:
MANISHA PRAKASH BAGUL / #tRuT TATAT TG PRAKASH CHANDRABHAN BAGUL / TWT
TAS / MOTHER'S AADHAAR NO TT / FATHER'S AADHAAR NO:
XXXXXXXX1468
XXXOXOX3572
IADDRESS OF PARENTS AT THE TIME HT-f I UFu TH PERMANENT ADDRESS OF PARENTS
Or bikIHOF THE CHILD:
ESIDENSI , KALANAGAR MERI PANCHAVATI RO HOUSE NO.8 SAI RESIDENSI, KALANAGAR MERI PANCHAVATI
NASHIK, NASHIK, NASHIK NASHIK NASHIK. NASHIK,
MAHARASHTRA MAHARASHTRA

far (H st.), rfars, fars, tars (H ), fars, fare,

t ATF REGISTRATION NUMBER: teut faE I DATE OF REGISTRATION:

B-2018. 27-90334-002177 02-06-2018

TT /REMARKS (F ANY):

THUT f f E | DATE OF ISSUE: frfifrA IUT0 VfAîI ISSUING AUTHORITY

02-01-2019

SUB-REGISTRAR (BIRTH &

MUNICIPAL CORPORATION NASHIK PANCHAVATI ZONE

UPDATED ON :
02-01-2019 13:31:36

THIS IS AcOMPUTER GENERATED CERTIFICATE wHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY
THE GOVT OF INDIA VIDE CIRCULAR NO I/12/2014-VS(CRS) DATED 27-JULY-2015HAS
APPROVED THIS CERTIFICATE AS AVALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES
T t tcca ar-et T/NSURE. REGIsTRATION OF EVFRY BIRTILANDIE ATH