सं.

1 चंडीगढ सरकार प-5

NO. 1 GOVERNMENT OF CHANDIGARH FORM-5
वाय सेवाएं वभाग
DEPARTMENT OF HEALTH SERVICES

सवल हॉिपटल, मानी माजरा, चंडीगढ़

CIVIL HOSPITAL, MANIMAJRA, CHANDIGARH

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा चंडीगढ जम मृयु रिजकरण नयम, 2000 के नयम 8/13 के अंतगत जार कया गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE CHANDIGARH REGISTRATION OF
BIRTHS & DEATHS RULES 2000)

यह मािणत कया जाता है ननलिखत सुचना जम के मूल अभलेख से ल गई है जो क सवल हॉिपटल, मानी माजरा, चंडीगढ़ तहसील चंडीगढ िजला चंडीगढ
राय/संघ देश चंडीगढ, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
CIVIL HOSPITAL, MANIMAJRA, CHANDIGARH OF TAHSIL/BLOCK CHANDIGARH OF DISTRICT CHANDIGARH OF STATE/UNION TERRITORY CHANDIGARH,
INDIA.

नाम / NAME: CHIRAYU KUMAR लंग / SEX: पुरष / MALE

ई-आईडी नंबर / EID NO.:

XXXXXXXXXXXXXXXXXXXXXXXX4201

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
21-08-2016
CIVIL HOSPITAL, MANIMAJRA, CHANDIGARH
TWENTY-FIRST-AUGUST-TWO THOUSAND SIXTEEN

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:

BABY DEVI MUKESH KUMAR

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF
BIRTH OF THE CHILD: PARENTS:
# 231, PIPLI WALA TOWN,
MANI MAJRA, , CHANDIGARH, CHANDIGARH, CHANDIGARH # 231, PIPLI WALA TOWN,
MANI MAJRA, CHANDIGARH, CHANDIGARH,
CHANDIGARH

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:

B-2016: 4-90002-001093 22-08-2016

टपणी / REMARKS (IF ANY):

TOB--3:32 PM

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
22-08-2016
उप-रिजार (जम एवं मृयु)
SUB-REGISTRAR (BIRTH & DEATH)
सवल हॉिपटल, मानी माजरा, चंडीगढ़
CIVIL HOSPITAL, MANIMAJRA, CHANDIGARH

UPDATED ON :
22-08-2016 11:34:46

"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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "