e14- FORM -5 |

GOVERNMENT OF GUJARAT

DEPARTMENT OF HEALTH AND FAMILY ELFARE

BIRTH CERTIFICATE
1 7 t H-42 -Ü4ll Mal, 2o0l MuH - </13 H6o1)
(Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969
and Rule 8/13 of the Gujarat Registration of Births and Deaths Rules, 2004)
***T **********
* * c i l d g l i L * * * * * . ** * * *

This is to
3/212-il RPrzHi B.
Certify that the following information has been taken from the original record of birth which is in the register
for Village/City}RoiE of Taluka. i e a . of District. .. . of Gujarat State.

ala (Y/Rol)"
1.
Name '
.21H. *

Sex (M/F)
.

5. Date of Birth 08-OG-AGGO. . Place of Birth 4ZGtER ***°** **

Name of Mother
UA9.RISI.. Name of Father: leO.0l.RIIL...
6.
.
Address of parents at the time of Birth of child 8. Permanent address of Paren:s
* *
********°**

*******°'***
qRus..
. iuel sHis 10. 4il-il duili '**'**°°'************

9. Registration No. 2C3G... 10. Date of Registration:Og-OC-ECO ******'********

********°***. **********************

********** .
11. Remarks (if any)

Signature of the issuing authority. ******

***********. ********************* ************"**

Date of issue G-OC-2090

*******
*********** * ************************ ****

******.****ea*** o*o*** *******°

OAN
SEAS

/ . Address of the is
Registration of every Birth & Dea
BAND Ensure
r
.LdL.A.>A. (aa) 19c-29,10,000--201
 G14- FORM -5

GOVERNMENT OF GUJARAT
DEPARTMENT OF HEALTH AND FAMILY WELFARE

BIRTH CERTIFICATE
( 4RL ilLeil All-144, 1eECril ta4 12/19
o1ld q-429L 1eil L4Hl, 200L 4 i - C/13 )

(Issued under Section 12/17 ofthe Registration of Births and Deaths Act, 1969
and Rule 8/13
of the Gujarat Registration of Births and Deaths Rules, 2004)
ecLl-L qsll ******
his 15pORBANBAR following KSen taken from hs griginal record of birth which is in the register
Ior Village:City......... ..... Ol laluka .......
PORBANDAR of Gujarat State.
. . .

.... . . Ol 1iStrict...... .. .
* * *

. alet (y/eil)
SHYAM...
1. Name Sex (M/F) Male ***

3. .
04-09-1990
Date of Birth 4. Place of Birth PORBANDAR,
. .
Name of Mother
JAYA LALII BHARADA.
6. Name of Father: LALJIJIVA BHARADA
******
******

Address of parents at the time of Birth of child . Permanent address of Parer!s

2939
10. i4el-l dl:****06-09-19900
9. Registration No. 10.
Date of Registration:
11. l (aau üa)
11. Remarks (if any)
***'*****

Signature of the issuing authority. ************

9HENA Sdl 4-il dtlu: **** "19-08-2017 ******* ** ************

************

Date of issue ********°* ************************* **********

***************************************

.SuRe ..
O&AND
AM
SEVA

Address of the issighhi h ent

Ensure Registration every Birth &Death MCR Aq
ar Naa: Seve da
PORES
.LL.. (avu) 19c-29,10,o00--201