Form-5

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

RURAL HOSPITAL MINAKHAN

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR RURAL HOSPITAL MINAKHAN OF BLOCK/MUNICIPALITY MINAKHAN OF DISTRICT NORTH 24 PARGANAS OF
STATE WEST BENGAL, INDIA.

NAME : TOHABIR HASSAN GENDER : MALE

DATE OF BIRTH : 19/02/2022 PLACE OF BIRTH : RURAL HOSPITAL MINAKHAN,

MINAKHAN, NORTH 24 PARGANAS, WEST
BENGAL

NAME OF MOTHER : TANUJA NASRIN NAME OF FATHER : ABDUL MUJID MOLLA

MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -

PRESENT ADDRESS OF MOTHER VILLAGE/TOWN:- MINAKHAN (CT),MINAKHAN BLOCK,DIST:- NORTH 24 PARGANAS,WEST BENGAL-
AT THE TIME BIRTH OF THE
CHILD :

PERMANENT ADDRESS OF VILLAGE/TOWN:- MINAKHAN (CT),MINAKHAN BLOCK,DIST:- NORTH 24 PARGANAS,WEST BENGAL-

MOTHER :

CERTIFICATE NO : B-2022: 19-02719- DATE OF REGISTRATION : 19/02/2022

000229

S-UHID : 53748161107762 REMARKS (IF ANY) :

DATE OF ISSUE : 04/03/2022 ISSUING AUTHORITY :

UPDATED ON : 2022-08-04 08:49:27

Signature Not Verified

Digitally Signed.
Name: DILIP BISWAS
Date: 05-Apr-2023 14:26:48

REGISTRAR (BIRTH & DEATH)

RURAL HOSPITAL MINAKHAN

"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

"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "