సంఖ 1 ఆంధ పే పభుతము ారం-5

NO. 1 GOVERNMENT OF ANDHRA PRADESH FORM-5

ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

MUNICIPAL CORPORATION KAKINADA

జనన ధృవ పతము

BIRTH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)
(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)

రత ేశము, ఆంధపే ాషము తూరు ోావి లా ాిాడ అర మండలము ముిపల ాొేష ాిాడ (ాక పేశము) జనన మరణ ిషేరులో జనాి
సంబంింన అసలు ిారు నుంి, ింి సమారము సుొనబినద ధృకించడైని.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
MUNICIPAL CORPORATION KAKINADA OF TAHSIL/BLOCK KAKINADA URBAN OF DISTRICT EAST GODAVARI OF STATE/UNION TERRITORY ANDHRA
PRADESH, INDIA.

రు / NAME: PILAKA UPAMANYU SASHANK ంగము / SEX: మగ MALE

పటిన ేీ / DATE OF BIRTH:

పటిన సలము/ PLACE OF BIRTH:
14-12-2018
SIDDARTHA HOSPITAL
FOURTEENTH-DECEMBER-TWO THOUSAND EIGHTEEN

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER:

VADALI JAYA LAKSHMI SUSHAMA PILAKA RAVI SHARMA

ఆా సంఖ / MOTHER'S AADHAAR NO: ఆా సంఖ / FATHER'S AADHAAR NO:
XXXXXXXX1060
XXXXXXXX0066

డ జంనపడు తలిదండులు రుామ / ADDRESS OF PARENTS AT THE TIME OF BIRTH తలిదండులు క ిరాసప రుామ/ PERMANENT
OF THE CHILD: ADDRESS OF PARENTS:
2-34-2, PLOT NO 4, M V P COLONY,
VISAKHAPATNAM, GVMC (PART), , VISAKHAPATNAM URBAN, VISAKHAPATNAM, ANDHRA 2-34-2, PLOT NO 4, M V P COLONY,
PRADESH- 530017 VISAKHAPATNAM, GVMC (PART), VISAKHAPATNAM URBAN,
VISAKHAPATNAM,
ANDHRA PRADESH- 530017

నదు సంఖ / REGISTRATION NUMBER: నదు ేీ / DATE OF REGISTRATION:

B-2018: 28-90018-005566 24-12-2018

ేాంశములు / REMARKS (IF ANY):

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ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY :
26-10-2019
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)

MUNICIPAL CORPORATION KAKINADA

UPDATED ON :
24-12-2018 00:00:00

"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".

" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "