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GOVERNMENT OF KI\RNAT/\}{A '.•
:-:.FJFJ ::1:i~ :l:>dr.rl\' O:!::J?.ol"
ChlcfRrglalm or Ul.r1h and Deal~ •

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form No. GiSee Rule 8) '
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BIRTH CERTIFICATE
Ussued Und er Sec tion l 2 / 171

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I laken from IIIL' origin31 record
or
nu~ i, to rfrt1f~ lhal 1he follo\\in~ information has: bL'f'I ril'I or Knrnalaka
alorr ,\luhana:,:11ra Palik<'. H:wgalon: lfol
b1nh "hich i\ in 1hr n~i\lCr or Uruluu lbng
Sl:.ih'.

,) _, '""' </J"'Jo{h t),;')..l_,fl.nm.:...~~.:...r0~. · · · · · · · · · ·


2) 3oc!Qll 15/GCD I ~amc of Fathc,... N.,. rg_ =:' ............. .

Name of Mo thc r~k "!,: f.ll '\!.L q,...1\,L


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6) nlsaeoo~ 3ae,e!lll 7) nlsaeoo~ ;;;o&?i

D;11c of rcgistr.111011.. J.tlo.5/.o'.f. - Reg N" .... ~G. b3.


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