सं.

1 मय देश सरकार प-5

NO. 1 GOVERNMENT OF MADHYA PRADESH FORM-5
योजना, आिथक एवं सांियक वभाग
DEPARTMENT OF PLANNING, ECONOMICS & STATISTICS
संजय गांधी मेडकल अपताल, रवा
SANJAY GANDHI MEDICAL HOSPITAL REWA

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा मय देश जम मृयु रिजकरण नयम, 1999 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 MADHYA PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 1999)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क संजय गांधी मेडकल अपताल, रवा तहसील हुज़ूर िजला रवा
राय/संघ देश मय 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 SANJAY GANDHI MEDICAL HOSPITAL REWA OF TAHSIL/BLOCK HUZUR OF DISTRICT REWA OF STATE/UNION TERRITORY MADHYA PRADESH,
INDIA.

नाम / NAME: DIVYANSHI NAMDEV लंग / SEX: महला / FEMALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
12-06-2022
SANJAY GANDHI MEDICAL HOSPITAL REWA
TWELTH-JUNE-TWO THOUSAND TWENTY TWO

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

RADHA NAMDEV DURGA PRASAD NAMDEV

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

XXXXXXXX5036

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:

BELA, , AMARPATAN, SATNA, MADHYA PRADESH BELA, AMARPATAN, SATNA,

MADHYA PRADESH

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

B-2022: 23-90516-003747 13-06-2022

टपणी / REMARKS (IF ANY):

2021891297611

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
13-06-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
संजय गांधी मेडकल अपताल, रवा
SANJAY GANDHI MEDICAL HOSPITAL REWA

UPDATED ON :
13-06-2022 14:49:22

"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 "