Form-5

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

MUNICIPALITY COOCH BEHAR

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 MUNICIPALITY COOCH BEHAR OF BLOCK/MUNICIPALITY MUNICIPALITY COOCH BEHAR OF DISTRICT
COOCHBEHAR OF STATE WEST BENGAL, INDIA.

NAME : TAMIM SHEKH GENDER : MALE

DATE OF BIRTH : 18/12/2022 PLACE OF BIRTH : PODDAR SEVA SADAN PVT. LTD.,
MUNICIPALITY COOCH BEHAR,
COOCHBEHAR, WEST BENGAL

NAME OF MOTHER : TARJINA KHATUN NAME OF FATHER : NUR MD SHEKH

MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : AADHAAR- XXXXXXXX0950

XXXXXXXX0456

PRESENT ADDRESS OF MOTHER LOCALITY:- CHILAKHANA,VILLAGE/TOWN:- CHILAKHANA,TUFANGANJ - I BLOCK,DIST:-

AT THE TIME BIRTH OF THE COOCHBEHAR,WEST BENGAL-736177
CHILD :

PERMANENT ADDRESS OF LOCALITY:- CHILAKHANA,VILLAGE/TOWN:- CHILAKHANA,TUFANGANJ - I BLOCK,DIST:-

MOTHER : COOCHBEHAR,WEST BENGAL-736177

CERTIFICATE NO : B/2023/250474 DATE OF REGISTRATION : 05/01/2023

S-UHID : 72334690455239 REMARKS (IF ANY) :

DATE OF ISSUE : 28/02/2023 ISSUING AUTHORITY :

UPDATED ON : 2023-02-28 15:18:00

Signature Not Verified

Digitally Signed.
Name: AMINA AHMED
Date: 28-Mar-2023 10:49:54

REGISTRAR (BIRTH & DEATH)

MUNICIPALITY COOCH BEHAR

"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 "