BIRTH CERTIFICATE

SERIAL N° 51171843
DATA OF THE REGISTRY OFFICE - CLASS OF OFFICE

Registrar Notary X Number Consulate Corregimiento Police Inspectorate code A4H

Country - Department - Municipality – Police Department

MO COLOMBIA, CUNDINAMARCA, BOGOTA

DATA OF THE REGISTERED
Surname Surname

CORTES***************** DIAZ ***************************.

Name

ESTEBAN**********************************
Date of Birth Gender Blood Group RH Factor
Year 2012 Month JUN Day 06 MALE…………………. A………………… Positive………..
Place of Birth (Country, Department, Municipality, Corregimiento, Police Inspectorate)
COLOMBIA – CUNDINAMARCA - BOGOTA………………………………………………………
TYPE OF BACKGROUND DOCUMENT OR WITNESS STATEMENT

CERTIFICATE OF LIVING BORN

DETAILS OF THE MOTHER
Surnames and Names
DIAZ OCHOA SUSANA ………………………………………………………………………………………………..
Identification Document (class and number) Nationality
CITIZENSHIP CARD N° 55312408 ……………………………… COLOMBIAN………………………………
DETAILS OF THE FATHER
Surnames and Names
CORTES RAMIREZ OSWALDO ………………………………………………………………………………………………..
Identification Document (class and number) Nationality
CITIZENSHIP CARD N° 80018091 ………………………… COLOMBIAN………………………………
DATA OF THE FIRST WITNESS
Surnames and Names
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Identification Document (class and number) Signature
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DATA OF THE FIRST WITNESS
Surnames and Names
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Identification Document (class and number) Signature
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Date of Inscription Name and signature of the official

Year 2012 Month JUNE Day 15

Paternal Recognition Name and signature of the official