Schedule

XXX--Form No. 8

FORM NO. 8

(See Rule 8)

BIRTH CERTIFICATE
Issucd Under Section 12)
This is to
certify that the following intormation has been taken from theis theoriginal record of birth, which
register
the register for
f (local arcas)
Parode efMUnC: rth,
Pafsjm which in

the . o o O .of Tahsil.....

KKuj'so
of District...
JagatraYha. of State of Orissa.
Name..Sarbha sdhan. Nanve of Mother. a
..
may e e Dsaolhan
..d******d "******************

Sex. .le Permanent Address roft bparents.7%.

aha.har.
Po - 1Badfa rda ,PS- kamha
Date of Birth... .206 . .. . . . ....

e of Birth. 2 araoleepe Registration No.. 3.O **

Z
Name of Father..agabsndk. Tdhen ************ Date of Registration.. 2 e 7

Dhute 1oapi ...

Signurar
Signaure of rth
[ssuing Authority

Exe Seal

OGP Forms) DTP-322-15.00.000-25-02-2006