0917899 CERTIFICATE OF BIRTH

l 184 Cerlified Copy

1y1 sis-4
Form No. 5(Seo Rule 8/13)
wRId 12812
GOVERNMENT OF GUJARAT
Fee Rs. 50

Department of Health

6sued underSecton 12/17of the Repistration of Births and Deaths Act, 1960 &under section 8 ofGujarat Births &Deaths Registnatdon Rules, 2004)

Amdavad Municipal Corporation

Me/iZ904s to certity thMl4/MESTing informatiSSWasden takenf dUNArecord

of Birth at Amdavad City of Saiaret State.
ALE/ Month Ho/ of 2018
(1) oilH
Name ANSHIKA

(R)
Sex FEMALE

(3) 31/03/2018
Date of Birth

(3)
Place of Birth ASTHA METERNITY AND NURSING HOME

(4)
Name of Father SHAILESHKUMAR AMBIKAPRASAD MISHRA

(S)
Name of Mother PRITI

() l7908,AStAdlbR, aotHlctRH oltl s, olat, uHEIAL

Address of Parents at the time of C/704, ASKA ELEGANCE, VANDEMATARM GOTA, AHMEDABAD
Birth of Child

(C) ll/90x,LRSINC{lIR, lotHld?H Nat ?ls , olal, UHEI

Permanent address of Parents C/704, ASKA ELEGANCE, VANDEMATARM GOTA, AHMEDABAD
(C) Tugl sis 2018-BW-0210-0000570
Registration No

(10) luel ddu 06/04/2018

Date of Registration
(11) 2l4HL`A/ Remarks

JALPA
DR. DIVYANG 0ZA
Set Holldotl2oll uél Hrtlastloll Nsl
Prepared By Checked By Signature of issuing authority
ALRlI LHLd (H HReu leleu)
NW-THALTEJ-CITY CIVIC CENTRE Department of Health(Births & Deaths
06/02/2019 HELCLE aAua suklot
Amdavad Municipal Corporation

OTE (1)h e case of birth no diedosum shall ba made of parioulars, regarding te cause of bith as enlored in thie regisler See pvision to Sub Section 17()
(K (2 Permurent sidcress and oresat adiess vere not
aplicable