Key No. B0070167-1005285 FORM No.

5
(See Rule 8)

tIcf kÀ¡mÀ
GOVERNMENT OF KERALA

\KcImcy hIp¸v
DEPARTMENT OF URBAN AFFAIRS kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv Xncph\´]pcw tImÀ¸tdj³ Name of Local Government issuing certificate Thiruvananthapuram Corporation

P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths Rules, 1999)

Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse Xncph\´]pcw Pnñbnse Xncph\´]pcw Xmeq¡nse Xncph\´]pcw tImÀ¸tdj³ þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
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) Thiruvananthapuram Corporation of Taluk Thiruvananthapuram of District Thiruvananthapuram of State Kerala.

---t]cv/ Name ---B¬/s]¬/ Sex ---P\\ XobXn/ Date of Birth ---P\\ Øew/ Place of Birth

: : : :

Um³ tPmÀPv sPÌn³ / DAN GEORGE JESTIN B¬/ Male
21/05/2010 TWENTY ONE/MAY/TWO THOUSAND TEN

tIcfm C³Ìnäyq«v Hm^v saUn¡ð kb³kkv, Xncph\´]pcw/
Kerala Institute Of Medical Sciences (KIMS), Thiruvananthapuram

---amXmhnsâ t]cv / Name of Mother ---]nXmhnsâ t]cv/ Name of Father Ip«nbpsS P\\ kab¯v amXm]nXm¡fpsS taðhnemkw Address of the parents at the time of birth of the child amXm]nXm¡fpsS Øncamb taðhnemkw Permanent address of parents cPnkvt{Sj³ \¼À/ :
Registration Number 13115/2010

: : : :

Pn³ adnbw PÌn³ / GEEN MARIAM JESTIN PÌn³ KohÀKokv / JESTIN GEEVARGHESE Bimcntb¯v hoSv, Nm¯¶p¸pg , Nqct¡mSv ]n H, ASqÀ, ]¯\wXn«, tIcfw, C³Uy
Assariathu House, Chathnnopuzha, Choorakodu P O, Adoor, Pathanamthitta, Kerala, India

:

Bimcntb¯v hoSv, Nm¯¶p¸pg , Nqct¡mSv ]n H, ASqÀ, ]¯\wXn«, tIcfw, C³Uy
Assariathu House, Chathnnopuzha, Choorakodu P O, Adoor, Pathanamthitta, Kerala, India

:

cPnkvt{Sj³ XobXn/ : 29/05/2010
Date of Registration :

---A`n{]mb¡pdn¸v/ Remarks (if any)

---\ðIp¶ XobXn/ Date of Issue \ðIp¶ A[nImcnbpsS taðhnemkw/
Address of the issuing authority

:

28/01/2013 (13:37)

Last Updated on 04/08/2010 (11:52)

:

Registrar of Births and Deaths , Thiruvananthapuram Corporation

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event. Software developed and supported by Information Kerala Mission. Certificate printed before the last updated date is invalid Page 1/1