Key No.

B0060859-1805291
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
]©mb¯v hIp¸v
DEPARTMENT OF PANCHAYAT
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv I®mSn {Kma ]©mb¯v
Name of Local Government issuing certificate Kannadi Grama Panchayat
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse ]me¡mSv Pnñbnse ]me¡mSv Xmeq¡nse I®mSn {Kma ]©mb¯v
þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local
body) Kannadi Grama Panchayat of Taluk Palakkad of District Palakkad of State Kerala.
---t]cv/ Name : t]cv cPnÌÀ sNbvXn«nñ / Name Not Registered
---B¬/s]¬/ Sex s]¬/ Female
:
---P\\ XobXn/ Date of Birth : 24/05/2018
TWENTY FOUR/MAY/TWO THOUSAND EIGHTEEN
---P\\ Øew/ Place of Birth :
]me\ C³Ìnäyq«v Hm^v saUn¡ð kb³kkv, I®mSn, ]me¡mSv, I®mSn/

Paalana Institute of Medical Sciences, Kannadi, Palakkad, Kannadi

---amXmhnsâ t]cv / Name of Mother k^v\. sI / Safna. K
:
---]nXmhnsâ t]cv/ Name of Father
: djoZv. _n / Rasheedh. B
Ip«nbpsS P\\ kab¯v : Zmdpð lwavZv, sFizcy \KÀ, ]pXp\Kcw (]n.H), ]n³þ 678503, ]me¡mSv,
amXm]nXm¡fpsS taðhnemkw tIcfw, C³Uy
Address of the parents at the time of : Dharul Hamdh, Aiswarya Nagar, Pudunagaram (P.O), Pin- 678503, Palakkad,
birth of the child Kerala, India

amXm]nXm¡fpsS Øncamb : Zmdpð lwavZv, sFizcy \KÀ, ]pXp\Kcw (]n.H), ]n³þ 678503, ]me¡mSv,
taðhnemkw tIcfw, C³Uy

Permanent address of parents : Dharul Hamdh, Aiswarya Nagar, Pudunagaram (P.O), Pin- 678503, Palakkad,
Kerala, India

cPnkvt{Sj³ \¼À/ : 320/2018 cPnkvt{Sj³ XobXn/ : 07/06/2018

Registration Number Date of Registration
---A`n{]mb¡pdn¸v/ Remarks (if any) :

---\ðIp¶ XobXn/ Date of Issue : 01/02/2022 (21:20) Last Updated on 07/06/2018 (14:24)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Kannadi Grama Panchayat

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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