You are on page 1of 1

00004F 1 {

Urban Are:'

FORM NO. 5
(See Rule 8)

q'*qc qflRFT
CHAN DIGARH ADM I NISTRATION
gft{4
w rdqr,T
DEPARTMENT OF HEALTH
qT( Ff{rq q"S.fq
M UNICIPAL CORPORATION, CHANDIGARH

Er;q qrT[q rH
Birth Certificate
(q.q fq rFffiqttq qfrhqq, 1969 d qN 12117 nw w&q-a Erq Tq Gr$tr{q Hzrq, zooo *
ffqq attg? d-trfil qrt Hqrrq)
(lssued under Section 12117 of the Registration of Births and Deaths Act, 1969 and
Rule 8/13 of the GFhndigarh Registration of Births and Deaths Rules, 2000)
qe rqFK frqr qdr t m 6qp'6o {tnr we * W te t dr r$B mfu(effiq dr) H6drq-
ffi
tr-dr {rq xxxxxxxxxx*xx**x**x*f **xxx****t***tx*x
+Tffis{frsffid?r
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)
aro*o,oo*r rr, ,oro
of Tehsil/Block_=o.*.'*=--
of Di.tti.t aro*o,"o*, of State/Union Territory
o,r,, aronu,uu*tt
qm / Name idr/ sex-
w"ry fr
frE/Date of Bidh sri, *se ler+ Gr*t Rn-{ / Place of Birth
F-ot +t il'q / Name of Father
,o, n*non*n r*ruw*n
qKI sr qiq / Name of Mother CHA};DIGAFi:
q-A + q=q * srrq qrdr mil sI wTr qrdr ft-dr qr en{ wr
Address of Parents at the time of birth of the child Permanent Address of Parents

il HANDIGARH MANIMAJ RA CHAN DIGARi-I


q+{tET dst/Registration No. Iitfiq-toT Fqim I Date of Reqistration i. !L a,
ffi
ZJUO -

ffi7P"r"rks any)* (if

authoritv
t. i -.- -.a ..
t$ry''ns ge tFqT{ /Chief Registrar
ENSURE REGISTRATION OFEVERY BIRTH AND DEATH /T&d qq qq Tq
-"
TI IiqIfivI gfrfF-d ri r
t

You might also like