Verified

that Smt. _______________________ w/o _________________________ resident

of ___________________________________________________ has given birth
to the 1st/2nd/3rd _______ Girl child. The name of 1st/2nd/3rd Girl child
Ms. ______________________________ has been registered in Anganwadi centre
_________________________________ 11 digit AWC code
Project Name ______________________

Signature of Supervisor/LHV* Signature of Anganwadi Worker/ANM

Name: Name:
Date: Date:
*LHV (Lady Health Volunteer) to sign in case of Urban Area where Anganwadi Centre is not existing.
----------------------------------------------------------------------------------------------------------------------------------
LkR;kfir
fd;k tkrk gS fd Jherh------------------------------------------------------------------------------ iRuh Jh -----------------------------
----------------------------------------------------------fuoklh-------------------------------------------------------------------------------------------------------
---------------------------------------------------- us izFke@ nwljh@ r`rh; yM+dh -------------------------------------------------------
dks tUe fn;k gS rFkk vkaxuokM+h dsUnz esa izFke @ nwljh@ r`rh; yM+dh---------------------------------
lqJh --------------------------------------------------------------------------------------- dk uke vkaxuokM+h dsUnz----------------------------
---------------------------------------------------------- 11 vadks dk dksM ifj;kstuk------
-------------------------------- ---------------------------------------------- esa iathd`r fd;k x;k gSA

Ik;Zos{kd@ysMh LokLF; Lo;alsoh ds gLrk{kj vkaxuokM+h dk;ZdrkZ@,-,u-,e- ds gLrk{kj

uke% uke%

rkjh[k% rkjh[k%

* ysMh LokLF; Lo;alsoh “kgjh {ks= ds lkbu gksxk tgka vkaxuokM+h dsUnz fon~;eku ugha gSA