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  • Form 5

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    Shivkant Thakur
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    This document is a birth certificate issued under the Registration of Births and Deaths Act of 1969 and the Bihar Registration of Births and Deaths Rules of 1999. It certifies the following information taken from the original birth record registered in the district of Bihar: The name of the child, date of birth, place of birth, name of mother and father. The addresses of the parents at the time of birth of the child and their permanent address are also included. The registration number, date of registration and date of issue of the certificate are stated. The issuing authority has signed with their address and official seal. A reminder is given to ensure registration of every birth and death.

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    This document is a birth certificate issued under the Registration of Births and Deaths Act of 1969 and the Bihar Registration of Births and Deaths Rules of 1999. It certifies the following information taken from the original birth record registered in the district of Bihar: The name of the child, date of birth, place of birth, name of mother and father. The addresses of the parents at the time of birth of the child and their permanent address are also included. The registration number, date of registration and date of issue of the certificate are stated. The issuing authority has signed with their address and official seal. A reminder is given to ensure registration of every birth and death.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    201 views1 page

    Form 5

    Uploaded by

    Shivkant Thakur
    This document is a birth certificate issued under the Registration of Births and Deaths Act of 1969 and the Bihar Registration of Births and Deaths Rules of 1999. It certifies the following information taken from the original birth record registered in the district of Bihar: The name of the child, date of birth, place of birth, name of mother and father. The addresses of the parents at the time of birth of the child and their permanent address are also included. The registration number, date of registration and date of issue of the certificate are stated. The issuing authority has signed with their address and official seal. A reminder is given to ensure registration of every birth and death.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    iz:i la[;k&5

    Form-5

    la
    No.

    fcgkj ljdkj

    lR;eso t;rs

    fcgkj ljdkj
    Government of Bihar
    ;kstuk ,oa fodkl foHkkx
    (DEPARTMENT OF PLANNING AND DEVELOPMENT)

    vFkZ ,oa lkaf[;dh funs'kky;


    DIRECTORATE OF ECONOMICS AND STATISTICS

    tUe izek.k&i=
    BIRTH CERTIFICATE
    tUe e`R;q jftLVhdj.k vf/kfu;e] 1969 dh /kkjk&12@17 rFkk fcgkj tUe e`R;q jftLVhdj.k
    fu;ekoyh] 1999 ds fu;e 8@13 ds vUrxZr tkjh fd;k x;kA
    (Issued under Section-12/17 of the registration of Births and Deaths Act, 1969 and Rule 8/13 of the Bihar
    Registration of Births and Deaths Rules, 1999)

    ;g izekf.kr fd;k tkrk gS fd fuEufyf[kr lwpuk ewy tUe vfHkys[k ls yh xbZ gS] tks fd
    LFkkuh; {ks=----------------------------- rglhyvapy@iz[kaM----------------------------------------------ftyk --------------------------------------------- jkT;% fcgkj ds jftLVj esa mfYyf[kr gSA
    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) ......................................................... of tahsil...........................................
    (anchal/block)...................................................... of District ............................................ of State : Bihar
    uke@Name................................................................................................................ fyax@ Sex......................................
    tUe frfFk@ Date of Birth..................................................... tUe LFkku@Place of Birth.......................................
    ekrk dk uke@Name of Mother...............................................................................
    firk dk uke@Name of Father......................................................................
    cPps ds tUe ds le; ekrk&firk dk irk@

    ekrk&firk dk LFkk;h irk@

    Address of Parents at the time of birth of the child

    Permanent address of the Parents

    ...........................................................................

    ....................................................................................

    ...........................................................................

    ....................................................................................

    ............................................................................

    ....................................................................................

    iathdj.k la[;k@ Registration No.......................................

    iathdj.k fnukad@Date of Registration .............................

    fVIi.kh@ Remarks(if any)......................................................


    tkjh djus dh frfFk@Date of issue....................................
    izkf/kdkjh ds gLrk{kj@ Signature of the issuing authority

    izkf/kdkjh dk irk@ Address of the issuing authority


    eksgj@Seal

    ^^ izR;sd tUe ,oa e`R;q dk iathdj.k lqfuf'pr djsa@Ensure registration of every birth and death**
    0379 Raju 28.12.10

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