Key No.

B0070167-1005285
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
\KcImcy hIp¸v
DEPARTMENT OF URBAN AFFAIRS
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv Xncph\´]pcw tImÀ¸tdj³
Name of Local Government issuing certificate Thiruvananthapuram Corporation
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse Xncph\´]pcw Pnñbnse Xncph\´]pcw Xmeq¡nse Xncph\´]pcw
tImÀ¸tdj³ þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local
body) Thiruvananthapuram Corporation of Taluk Thiruvananthapuram of District Thiruvananthapuram of State Kerala.
---t]cv/ Name : / BEEYATHUMMA KANAKKANTHODY KUNJAIMU
---B¬/s]¬/ Sex
: െപൺ/ Female
---P\\ XobXn/ Date of Birth 02/02/1965
: TWO/FEBRUVARY/ONE THOUSAND NINE HUNDRED SIXTY FIVE
---P\\ Øew/ Place of Birth :
tIcfm C³Ìnäyq«v Hm^v saUn¡ð kb³kkv, Xncph\´]pcw/

Kerala Institute Of Medical Sciences (KIMS), Thiruvananthapuram

---amXmhnsâ t]cv / Name of Mother
:
---]nXmhnsâ t]cv/ Name of Father
:
Ip«nbpsS P\\ kab¯v :
amXm]nXm¡fpsS taðhnemkw

Address of the parents at the time of :

birth of the child
amXm]nXm¡fpsS Øncamb :
taðhnemkw

Permanent address of parents :

cPnkvt{Sj³ \¼À/ : 13215/2010 cPnkvt{Sj³ XobXn/ : 29/05/2010

Registration Number Date of Registration
---A`n{]mb¡pdn¸v/ Remarks (if any) :

---\ðIp¶ XobXn/ Date of Issue : 28/01/2013 (13:37) Last Updated on 04/08/2010 (11:52)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Thiruvananthapuram Corporation

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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