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Certificate No.

6sE District

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Village Code

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COMMUNITY NATIVITY AND DATE OF BIRTH CERTIFICATE

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The constitution (sche'c2*'? car;tes) o+/er.

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l'he constiruric,n
S.Cs, S.Ts, Lisr Mflificarion)

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The S.Cs and S.1y'(r\menclrr-,.nt,,'A.r . 19j6.


v---._,-G'o' MS. No' r793, Educlrion Depr. dared 23-9-r970 as anended
from time ro rime (B.cs.)
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4, It is cerlified thar th;: [-)ate ot'


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the declaration given by

is/her father/mochen'guardian and as

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Date

3:O o& elgicaods /


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tered in the school Records where he/she studied.

Sigrrature

Designation

Name in Capital leuers

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