1

NO. 1

GOVERNMENT OF ANDHRA PRADESH

-5
FORM-5

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DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

GRAMA PANCHAYAT JANGAVANDLA PALLE

BIRTH CERTIFICATE
( 1969, 12/17 , 1999, 8/13 )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION OF
BIRTHS & DEATHS RULES 1999)

, ( )
, .
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
GRAMA PANCHAYAT JANGAVANDLA PALLE OF TEHSIL/BLOCK CHINNAGOTTIGALLU OF DISTRICT CHITTOOR OF STATE/UNION TERRITORY ANDHRA
PRADESH, INDIA.

/ NAME: T BHARGAVAREDDY

/ SEX: MALE

/ DATE OF BIRTH:
23-08-1995
TWENTY-THIRD-AUGUST-ONE THOUSAND NINE HUNDRED NINETY
FIVE

/ PLACE OF BIRTH:
1-16, BODIREDDYGARIPALLI, JANGAVANDLAPALLI,
THIPPIREDDIGARIPALLE,CHINNAGOTTIGALLU, CHITTOOR,
ANDHRA PRADESH, 517192
,, ,
, 517192

/ NAME OF MOTHER:
T VANI /

/ NAME OF FATHER:
T VASUDEVAREDDY /

/ MOTHER'S UID NO:

7144 9774 0868

/ FATHER'S UID NO:

7360 5071 4413

/ ADDRESS OF PARENTS AT
THE TIME OF BIRTH OF THE CHILD:
1-16, BODIREDDYGARIPALLI,
JANGAVANDLAPALLI, THIPPIREDDIGARIPALLE, CHINNAGOTTIGALLU,
CHITTOOR,
ANDHRA PRADESH- 517192

/ PERMANENT ADDRESS OF PARENTS:

1-16, BODIREDDYGARIPALLI,
JANGAVANDLAPALLI, THIPPIREDDIGARIPALLE, CHINNAGOTTIGALLU, CHITTOOR,
ANDHRA PRADESH- 517192

, ,
- 517192
/ REGISTRATION NUMBER:
B-2016: 28-11799-000001

, ,
- 517192

/ DATE OF REGISTRATION:
21-01-2016

/ REMARKS (IF ANY):

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/ DATE OF ISSUE:
21-01-2016

/ ISSUING AUTHORITY :
( )
REGISTRAR (BIRTH & DEATH)

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" 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".
THE AUTHENTICITY OF THIS CERTIFICATE CAN BE VERIFIED FROM THE WEBSITE CRSORGI.GOV.IN.
THE REGISTRATION NUMBER IS UNIQUE TO EACH EVENT.
" , 21 " / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "