ফর্ম-৫

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE Form-5

DISTRICT HOSPITAL ALIPURDUAR

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969 AND RULE 8/13 OF THE
WEST BENGAL REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF
BIRTH WHICH IS THE REGISTER FOR DISTRICT HOSPITAL ALIPURDUAR OF BLOCK/MUNICIPALITY ALIPURDUAR
OF DISTRICT ALIPURDUAR OF STATE WEST BENGAL, INDIA.

NAME: NURI TAMANG GENDER: MALE

DATE OF BIRTH: 25/12/1991 PLACE OF BIRTH: HOME

NAME OF MOTHER: DIL MAYA TAMANG NAME OF FATHER: RAMAYA TAMANG

MOTHER'S IDENTITY FATHER'S IDENTITY

AADHAAR- XXXXXXXX AADHAAR- XXXXXXXX
PROOF: PROOF:

PRESENT ADDRESS OF
TORSA TEA GARDEN, DALSINGPARA, JAIGAON, DIST.- ALIPURDUAR, WEST BENGAL,
MOTHER AT THE TIME
PIN: 735208
BIRTH OF THE CHILD:

PERMANENT ADDRESS TORSA TEA GARDEN, DALSINGPARA, JAIGAON, DIST.- ALIPURDUAR, WEST BENGAL,
OF MOTHER: PIN: 735208

CERTIFICATE NO : B/2024/910161 DATE OF REGISTRATION: 16/07/2024

S-UHID: 85069672403428 REMARKS (IF ANY):

DATE OF ISSUE : 16/07/2024 ISSUING AUTHORITY •

UPDATED ON: 2024-07-16 10:07:54

Signature Valid

Digitally Signed.
Name: PRAFUL TAMINJ
Date: 16/07/2024 10:07:54
REGISTRAR (BIRTH & DEATH)
DISTRICT HOSPITAL ALIPURDUAR
"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 "