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
सामुदायक वाय के रामपुर नैकन
COMMUNITY HEALTH CENTRE RAMPUR NAIKIN

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 सामुदायक वाय के रामपुर नैकन तहसील रामपुर नईकन
िजला सधी 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 COMMUNITY HEALTH CENTRE RAMPUR NAIKIN OF TAHSIL/BLOCK RAMPUR NAIKIN OF DISTRICT SIDHI OF STATE/UNION TERRITORY MADHYA
PRADESH, INDIA.

नाम / NAME: GARVIT SINGH TOMAR` लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
18-10-2018
COMMUNITY HEALTH CENTRE RAMPUR NAIKIN
EIGHTEENTH-OCTOBER-TWO THOUSAND EIGHTEEN

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

PREETI SINGH TOMAR GAURAV SINGH TOMAR

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX0618
XXXXXXXX3180

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
BIRTH OF THE CHILD:
WARD-09 SOUTH KARAUNDIYA, WARD-09 SOUTH KARAUNDIYA,
KARAUNDIYA TOLA, , GOPADBANAS, SIDHI, MADHYA PRADESH KARAUNDIYA TOLA, GOPADBANAS, SIDHI,
MADHYA PRADESH

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

B-2022: 23-90812-000520 24-03-2022

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
24-03-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
सामुदायक वाय के रामपुर नैकन
COMMUNITY HEALTH CENTRE RAMPUR NAIKIN

UPDATED ON :
24-03-2022 17:31:37

"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 "