FORM 5C ‘See Rule 3 GOVERNMENT OF KERALA VENGARA VILLAGE OFFICE NATIVITY CERTIFICATE No, 58419763 Date: 27/08/2021 Certified that the person with the details mentioned below is a native of Kerala State. Name of Person to whom certificate is GuamssebvRSeENTEE issued Gender Male Age 19 Name of Father "| MOHIYADHEEN Address | KALLUPARAMBAN HOUSE, 438, KACHERIPPADI Post Office with Pin code KOORIYAD, 676306 Name of Localbody |Vengara village |Vengara es Taluk Tirurangadi — | District Malappuram State Kerala Date of Issue of Certfcate 27/08/2021 [Designation ofthe issuing officer =| VILLAGE OFFICER ‘This ceca is issued based on the details given inthe application, local enquty, facts and records produced and is vali for eiong ‘Security Code : 64ND2 Signature valid Digitally sign OD KS. Date: 2027.08, 8:00 IST 1. This dgtaly signed document is egal ala a per the Information Technology (FF) Act, 2000, 2. Authentety of this document can be vetfie fom htip/lecisriet Kerala gov.n/ and submiting the Corticate Number anc Secu code. Altematvely, please call the numbers 155300(rom BSNL landline), 0471185300(rom BSNL mobile), (04712395523/04712118004/04712115008(ftom other networks) and quote the Cetiicate Number to the operator.