सं.

1 हरयाणा सरकार प-5

NO. 1 GOVERNMENT OF HARYANA FORM-5
वाय सेवाएं वभाग
DEPARTMENT OF HEALTH SERVICES
नागरक अपताल पलवल
CIVIL HOSPITAL PALWAL

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा हरयाणा जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE HARYANA REGISTRATION OF
BIRTHS & DEATHS RULES 2002)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क नागरक अपताल पलवल तहसील पलवल िजला पलवल
राय/संघ देश हरयाणा, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER
FOR CIVIL HOSPITAL PALWAL OF TAHSIL/BLOCK PALWAL OF DISTRICT PALWAL OF STATE/UNION TERRITORY HARYANA, INDIA.

नाम / NAME: HENSH TANWAR लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
14-08-2023
CIVIL HOSPITAL PALWAL
FOURTEENTH-AUGUST-TWO THOUSAND TWENTY THREE

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:

POOJA DEEPAK

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF माता-पता के थायी पता/ PERMANENT ADDRESS OF
BIRTH OF THE CHILD: PARENTS:

DEEGHOT, , HODAL, PALWAL , HARYANA

DEEGHOT, HODAL, PALWAL ,
HARYANA

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:

B-2023: 6-90194-003104 28-08-2023

टपणी / REMARKS (IF ANY):

OK

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
14-12-2023
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नागरक अपताल पलवल
CIVIL HOSPITAL PALWAL

UPDATED ON :
14-12-2023 04:56:23

"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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "