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
ाम पंचायत फुलवमौ
GRAMA PANCHAYAT FULWAMAU

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 ाम पंचायत फुलवमौ तहसील फतेहपुर िजला फतेहपुर
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 GRAMA PANCHAYAT FULWAMAU OF TAHSIL/BLOCK FATEHPUR OF DISTRICT FATEHPUR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

नाम / NAME: AKANKSHA SINGH लंग / SEX: महला / FEMALE

जम तथ / DATE OF BIRTH: जम थान/ PLACE OF BIRTH:

11-04-2017 FULWAMAU, CHURIYANI,
ELEVENTH-APRIL-TWO THOUSAND SEVENTEEN FULWAMAU,FATEHPUR, FATEHPUR,
UTTAR PRADESH, 212601

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

UTTARA DEVI RAGHVENDRA SINGH

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX6970
XXXXXXXX0204

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
TIME OF BIRTH OF THE CHILD:
SARSAUL, SARSAUL,
SARSAUL, KANPUR, , KANPUR , KANPUR NAGAR, UTTAR PRADESH- 209402 SARSAUL, KANPUR, KANPUR , KANPUR NAGAR,
UTTAR PRADESH- 209402

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

B-2022: 9-25563-000003 25-11-2022

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
25-11-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत फुलवमौ
GRAMA PANCHAYAT FULWAMAU

UPDATED ON :
25-11-2022 08:03:53

"THIS IS A COMPUTER GENERATED CERTIFICATE. "

" 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 "