Birth

Date of GOVERNMENT
6..Date : ) (ST Place
(AOA )(f9otName Birth
) of
Name
of
This
ofFather MRAFPI is
Mother to
2S.09.0S(2c|0|2e)
Sub.i.HoSpitad,
Pradhan
kgp. certify
172234
OF
MUNICIPALTY
KGP, that WEST
the BENGAL
following

(See
[Issued
information
Rule
under No
of
Sex
9
(âi/) ()Name has
CERTIFICATE
sec. BIRTHOF of
been 17 West

lanmey..Pradhan. KHARAGPUR(T)
taken the
of Bengal

Registration (FormNo.5)
Registration
Male. from
the
original of
Births
of
Birth
RegistrationNo. : record
Dat(atsTE
e )A PS.......2 and and
of Deaths Deaths
Registration of
PASCHM birth
Act. Rules
which
1969]
ySeal)
(R4*a1 MEDINPUR is
2000
Signature :006 in
the )
register
of DEPARTMENT
HEALTHOF
eaths Issuing
Births &
District WELFARE
FAMILY &
RRtrar Tor.
kuthoity
of(Local
area) No.
West

Bengal.