Form.No.

Translated Verslon
GOVERNMENT OF GUJARAT
DEPARTMENT OF HEALTH AND FAMILY WELFARE

BIRTH CERTIFICATE
(lssued under Section 12/17 of the Registration of Birth and Deaths Act, 1969
and Rule 8/13 of the Gujarat
Registration of Birth and Deaths Rules 2004)
This is to Certify that the following information has been taken from the original record
of the birth which is in the
register for Village/City PALANPUR of Taluka PALANPUR of District
BANASKANTHA of Gujarat State
1. Name
VARUN 2.Sex (M/F) MALE
3. Date of Birth 13/12/1997 4.Place of Birth FEMALEHOSPITAL
PALANPUR
5. Name of Mother LEENABEN 6.Name of Father:

MAHESHKUMAR BHOGILAL MODH

7. Address of parents at the time of 8. Permanent Address of parents
Birth of Child

PALANPUR PALANPUR
9. Registration No. 7930 10.Dateof Registration:19/12/1997
|11. Remarks (if any)
Date of lssue 06/05/2014 Signature of the issuing Authority:

PalaPanpurlanpur
C p a l i y .
Sub Begistrar
Birth & Death g515121 b
l
Palanpur Nagarpalika
Address of the lssuing Authority
Ensure Registration of every Birth & Death