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Directorate of Economics and Statistics, M. P.

Chief Registrar, Birth-Death Registration

Birth Certificate
Book No. No.

( Birth certificate issued under Section 12/17 Registration of birth & death Act 1936 )

This is to certify that the following information has been taken from the original record of Birth which is in the register for . Municipality of Tehsil , District .., State Madhay Pradesh, India.

Name.. ..............Gender. .... Date of Birth.Birth Place..... Fathers Name ..Mothers Name....................... . Registration No.. ...Registration Date.. Parents Address.. Nationality of Parents................

Signature of issuing officer Chief Registrar ( Seal ) Date: -................Outgoing No..... Birth-Death Registration, Directorate of Economics and Statistics, M. P.

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