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

नगर नगम सहारनपुर

NAGAR NIGAM SAHARANPUR

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 सुचना जम के मूल अभलेख से ल गई है जो क नगर नगम सहारनपुर तहसील सहारनपुर िजला सहारनपुर 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
NAGAR NIGAM SAHARANPUR OF TAHSIL/BLOCK SAHARANPUR OF DISTRICT SAHARANPUR OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

नाम / NAME: INAYAT लंग / SEX: महला / FEMALE

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

01-06-2020 HOUSE NO 154-A, NEAR CHOTI MASJID, GHATHERA, GHAT
FIRST-JANUARY-TWO THOUSAND TWENTY HERA, BUDHAKHERA, SAHARANPUR
UTTAR PRADESH-247231

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

RAISA IKRAM

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 माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
TIME OF BIRTH OF THE CHILD: HOUSE NO 154-A, NEAR CHOTI MASJID, GHATHERA, GHAT
HOUSE NO 154-A, NEAR CHOTI MASJID, GHATHERA, GHAT HERA, BUDHAKHERA, SAHARANPUR
HERA, BUDHAKHERA, SAHARANPUR UTTAR PRADESH-247231
UTTAR PRADESH-247231
पंजीकरण तारख / DATE OF REGISTRATION:
पंजीकरण संया / REGISTRATION NUMBER: 28-01-2020
B-2020: 9-90002-008145

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
28-01-2020
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नगर नगम सहारनपुर
NAGAR NIGAM SAHARANPUR

UPDATED ON :
28-01-2020 17:09:40

"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 "