English Translated Version of the Original in Bengali BRC Form-3 People’s Republic of

Bangladesh
Office of the Registrar of Birth and Death
Banwarinagar Union Paridhad
Faridpur, Pabna, Bangladesh

Birth Certificate
(Copy from the Birth Registration Book)

Registration Book No : 0 0 4

Registration Date: 28 / 04 / 2011 Certificate Issue Date: 28 / 04 / 2011

Day Month Year Day Month Year
Registration No: 2 9 0 8 0 3

Personal Identification No: 2 0 0 3 2 6 1 1 2 3 3 0 6 2 0 6 9

Name: MEHEDI HASAN

Date of Birth: in number (AD) : 29– 08- 2003 Gender: Female Male
In word (AD) : Twenty Nine August Two Thousand & Three

Place o f Birth: Village- Purbo Dogair, 64 No. Ward, UP- Sarulia

Upazila- Demra, District- Dhaka

Father’s Name: MD. MAFIZUR RAHMAN Nationality: BANGLADESHI

Mother’s Name: FATEMA AKTER Nationality: BANGLADESHI

Permanent Address: Village- Purbo Dogair, UP- Sarulia

Upazila- Demra, District- Pabna
(Signature, Name &Seal of the person Prepared) (Signature, Name & Seal of the Registrar)