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Birth Certificate Sample

This document is a birth certificate that provides key details about the birth of an individual including their name, sex, date and place of birth, names and Aadhaar numbers of the mother and father, addresses of the parents at the time of birth and currently, registration number and date, date of issue, and signature and address of the issuing authority. The certificate confirms that the information was taken from the original birth record registered with the local body in the specified district, state/union territory of India as required by law.

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Jagdamba Overseas
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7K views1 page

Birth Certificate Sample

This document is a birth certificate that provides key details about the birth of an individual including their name, sex, date and place of birth, names and Aadhaar numbers of the mother and father, addresses of the parents at the time of birth and currently, registration number and date, date of issue, and signature and address of the issuing authority. The certificate confirms that the information was taken from the original birth record registered with the local body in the specified district, state/union territory of India as required by law.

Uploaded by

Jagdamba Overseas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

No.

Form-5

GOVERNMENT OF ....................

DEPARTMENT OF...................../..............................
(Name of local body issuing certificate)

BIRTH CERTIFICATE
(Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and Rule 8/13
of the ................................. Registration of Births and Deaths Rules.........................................
(Name of State) (Year of notifying the revised rules)

This is to certify that the following information has been taken from the original record of birth which
is the register for (local area/local body) ........................................................................... of tahsil /
block ................................ of District ................................ of State/Union territory
....................................

Name: ..........................................................................................
Sex................................................................................................
Date of Birth..................................................................................
Place of birth.................................................................................
Name of Mother............................................................................
Aadhaar No of Mother ………………………………………………………

Name of Father ....................................................................


Aadhaar No of Father ……………….……………………………….

Address of parents at the time of birth of the child: Permanent address of parents:
........................................................... ............................................................
........................................................... ............................................................
........................................................... ............................................................
……………………………………… ……………………………………….
Registration No: .......................... Date of Registration................
Remarks (if any) ...........................
Date of issue: ……................

Signature of the issuing authority……………………………….

Address of the iessuing


authority…………………………………………………………………………………………………

Seal

Ensure registration of every birth and death

No. Form-5 GOVERNMENT OF .................... DEPARTMENT OF...................../.....................

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