సంఖ 1 ఆంధ పే పభుతము ారం-5

NO. 1 GOVERNMENT OF ANDHRA PRADESH FORM-5

ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

MUNICIPAL CORPORATION VIJAYAWADA

జనన ధృవ పతము

BIRTH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION
OF BIRTHS & DEATHS RULES 1999)

రత ేశము, ఆంధపే ాషము జయాడ అర లా ఎనీఆ మండలము ముిపల ాొేష జయాడ (ాక పేశము) జనన మరణ ిషేరులో
జనాి సంబంింన అసలు ిారు నుంి, ింి సమారము సుొనబినద ధృకించడైని.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER
FOR MUNICIPAL CORPORATION VIJAYAWADA OF TAHSIL/BLOCK VIJAYAWADA URBAN OF DISTRICT NTR OF STATE/UNION TERRITORY ANDHRA
PRADESH, INDIA.

రు / NAME: ంగము / SEX: సీ FEMALE

పటిన ేీ / DATE OF BIRTH:

పటిన సలము/ PLACE OF BIRTH:
10-07-2023
BLOSSOMS RESEARCH CENTER AND HEALTH CARE VIJAYAWADA
TENTH-JULY-TWO THOUSAND TWENTY THREE

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER:

BURLA YAMINI LAKSHMI TELLA THRIVIKRAM RAO

ఆా సంఖ / MOTHER'S AADHAAR NO: ఆా సంఖ / FATHER'S AADHAAR NO:
XXXXXXXX0194
XXXXXXXX4417

డ జంనపడు తలిదండులు రుామ / ADDRESS OF PARENTS AT THE తలిదండులు క ిరాసప రుామ/ PERMANENT ADDRESS OF
TIME OF BIRTH OF THE CHILD: PARENTS:
6-72, GANDHIBOMMA STREET,
THIMMASAMUDRAM, THIMMASAMUDRAM, , NAGULUPPALA PADU, 6-72, GANDHIBOMMA STREET,
PRAKASAM, ANDHRA PRADESH- 523185 THIMMASAMUDRAM, THIMMASAMUDRAM, NAGULUPPALA PADU,
PRAKASAM,
ANDHRA PRADESH- 523185

నదు సంఖ / REGISTRATION NUMBER: నదు ేీ / DATE OF REGISTRATION:

B-2023: 28-90032-006891 19-07-2023

ేాంశములు / REMARKS (IF ANY):

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ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY :
25-07-2023
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)

MUNICIPAL CORPORATION VIJAYAWADA

UPDATED ON :
19-07-2023 00:00:00

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" 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".

" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "