FROM-6

GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH SERVICES
SONAI PRIMARY HEALTH CENTRE

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969AND RULE 8/13 OF THE ASSAM
REGISTRATION OF BIRTHS 7 DEATHS RULES 1999)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR SONAI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION
TERRITORY ASSAM INDIA.

NAME : MEHBUB ALOM MAZUMDER SEX: MALE

DATE OF BIRTH PLACE OF BIRTH:

04-10-2017 SONAI PRIMARY HEALTH CENTRE
FOURTH OCTOBER TWO THOUSAND CACHAR, ASSAM – 788119
SEVENTEEN

NAME OF MOTHER: NAME OF FATHER

HASNA BEGUM MAZUMDER AJIR UDDIN MAZUMDER

MOTHER’S AADHAR NO: FATHER’S AADHAR NO:

ADDRESS OF PERENTS AT THE TIME OF BIRTH PERMANENT ADDRESS OF PERENTS:

BHOURIKANDI PT I PO- HATIKHAL BAZAR BHOURIKANDI PT I PO- HATIKHAL BAZAR

CACHAR, ASSAM - 788116 CACHAR, ASSAM - 788116

REGISTRATION NO: DATE OF REGISRTAION:

B:2021 18-12394-551244 07-09-2021

REMARKS (IF ANY):

---
DATE OF ISSUE: ISSUING AUTHORITY
25-11-2021 REGISTRAR (BIRTH & DEATH)
SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
23-06-2024 02:26:15

“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”