सं.

1 उराखंड सरकार प-5

NO. 1 GOVERNMENT OF UTTARAKHAND FORM-5
चकसा वाय एवं परवार कयाण वभाग
DEPARTMENT OF MEDICAL HEALTH AND FAMILY WELFARE
ाम पंचायत नकुद
GRAMA PANCHAYAT NANKUDI

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उराखंड जम मृयु रिजकरण नयम, 2003 के नयम 8/13 के अंतगत जार कया गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTARAKHAND REGISTRATION OF BIRTHS &
DEATHS RULES 2003)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क ाम पंचायत नकुद तहसील डीडीहाट िजला पथौरागढ़ राय/संघ देश उराखंड,
भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR GRAMA
PANCHAYAT NANKUDI OF TAHSIL/BLOCK DIDIHAT OF DISTRICT PITHORAGARH OF STATE/UNION TERRITORY UTTARAKHAND, INDIA.

नाम / NAME: JANKI / जानक लंग / SEX: महला / FEMALE

आधार नंबर / AADHAAR NO.:

XXXXXXXX0158

जम तथ / DATE OF BIRTH: जम थान/ PLACE OF BIRTH:

01-07-1965
FIRST-JULY-ONE THOUSAND NINE HUNDRED SIXTY FIVE MAHAT GAON,DIDIHAT, PITHORAGARH,
UTTARAKHAND, 262543

महत गावं ,डीडीहाट, पथौरागढ़,

उराखंड, 262543

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:

MANGALA DEVI / मंगला देवी PRATAP SINGH / ताप संह

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
BIRTH OF THE CHILD:

MAHAT GAON, DIDIHAT, PITHORAGARH, MAHAT GAON, DIDIHAT, PITHORAGARH,

UTTARAKHAND- 262543 UTTARAKHAND- 262543

महत गावं , डीडीहाट, पथौरागढ़, महत गावं , डीडीहाट, पथौरागढ़,

उराखंड- 262543 उराखंड- 262543

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:

B-2024: 5-04374-000002 09-01-2024

टपणी / REMARKS (IF ANY):

WITH AFFIDAVIT

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
09-01-2024
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत नकुद
GRAMA PANCHAYAT NANKUDI

UPDATED ON :
09-01-2024 10:09:08

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" 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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "