NO.

1 FORM-5

GOVERNMENT OF UTTAR PRADESH

DEPARTMENT OF MEDICAL AND HEALTH

NAGAR NIGAM AGRA

BIRTH CERTIFICATE

( )

(ISSUED UNDER SECTIONS 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969 AND RULE 8/13 OF THE UTTAR PRADEHS
REGISTRATION OF BIRTHS & DEATHS RULES 2002)

THIS IS CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE
REGISTER FOR NAGAR NIGAM AGRA OF TAHSIL/BLOCK AGRA OF DISTRICT AGRA OF STATE/UNION TERRITORY UTTAR PRADESH INDIA

NAME: HIMANSHU MOHNANI Sex :Male/

DATE OF BIRTH PLACE OF BIRTH

07/05/2021 AGARWAL HOSPITAL
SEVEN-MAY-TWOTHOUSAND TWENTY ONE KAMLA NAGAR, AGRA

NAME OF MOTHER NAME OF FATHER

POOJA MOHNANI VARUN KUMAR MOHNANI

MOTHER’S AADHAAR NO. FATHER’S AADHAAR NO.

XXXXXXXX0555 XXXXXXXXX6913

ADRESSOF THE / PERMANENT

PRESENTAT THE TIME OF BIRTH OF THE CHILD ADDRESS OF PERENTS

33/12-8 E LOHIYA NAGAR, 33/12-8 E LOHIYA NAGAR
BALKESHWAR, AGRA, BALKESHWAR ,AGRA,
UTTAR PRADESH UTTAR PRADESH
REGISTRATION NO. DATE OF REGISTRATION
C-2021: 9 90170 009191356 08-06-2021

REMARKS (IF ANY)

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DATE OF ISSUE. ISSUING AUTHORITY

14-06-2021 )
SUB REGISTRAR (BIRTH & DEATH)

NAGAR NIGAM AGRA

UPDATED ON
14.06.2021.00.00.00

THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FASCSIMILE SIGNATURE OF THE ISSUING AUTHORITY
THE GOVT OF INDIA VIDE CIRCULAR NO 0/12/2014-VS(CRS)DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES.
* ENSURE REGISTRATION OF EVERY BIRTH AND DEATH*