सं.

1 उर देश सरकार प-5

NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाथमक वाय क चैल
PRIMARY HEALTH CENTRE CHAIL

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 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 UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क ाथमक वाय क चैल तहसील चैल िजला कौशाबी
राय/संघ देश उर देश, 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 PRIMARY HEALTH CENTRE CHAIL OF TAHSIL/BLOCK CHAIL OF DISTRICT KAUSHAMBI OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

नाम / NAME: SAKSHI YADAV लंग / SEX: महला / FEMALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
03-02-2013
PHC CHAIL
THIRD-FEBRUARY-TWO THOUSAND THIRTEEN

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

SUNITA DEVI SUNIL YADAV

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 माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
SHAIKH SARWA, SHAIKH SARWA,
BAMROULI UPARHAR, SHAIKH SARWA, , ALLAHABAD, PRAYAGRAJ, UTTAR BAMROULI UPARHAR, SHAIKH SARWA, ALLAHABAD,
PRADESH- 211012 PRAYAGRAJ,
UTTAR PRADESH- 211012

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

B-2021: 9-91354-000632 03-02-2021

टपणी / REMARKS (IF ANY):

NA

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
03-02-2021
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाथमक वाय क चैल
PRIMARY HEALTH CENTRE CHAIL

UPDATED ON :
03-02-2021 16:46:24

"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 "