.

1 GOVERNMENTOFHARYANA FORM-5
NO. 1 SERVICES
DEPARTMEMT OF HEALTH
PHCPALLA

BIRTH CERTIFICATE

AuH 8/13 +
tfoGU yH. 2002 THE HARYANA REGISTRATION OF BIRTHS
Hy AND RULE 8/13 OF
ACT, 1969
OED UNDEP CECTION 12/17 OF THE REGISTRATION OF BIRTHS &DEATHS
&
DEATHS RULES 2002)
WHICH IS THE REGISTER FOR
OF BIRTH
FROM THE ORIGINAL RECORDINDIA.
TAKEN HARYANA,
1hIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN STATE/UNION TERRITORY
PHC PALLA TAHSIL/BLOCK FARIDABAD OF DISTRICT FARIDABAD OF
OF

feT /SEX: yEq/ MALE

H NAME:
BIRTH:
GH TYA PLACE OF /YTt qELY GE yedI
GA faf DATE OF BIRTH: PRIMARY HEALTH CENTRE, PALLA
28-12-2023
TWENTY-EIGHTH-DECEMBER-TWO THOUSAND TWENTY THREE
fua I AH NAME OF FATHER:
AAT AT A / NAME OF MOTHER: RAVINDER SINGH/ taTfa
JULI KUMARI / gett gATT
AADHAARNO:
GHTEJTT q / FATHER'S
3TeITT T/ MOTHER'S AADHAAR NO: XXXXXXCX1705

XXXXXXXX5464 PARENTS:
HAT-fMAT TÊT ya/ PERMANENT ADDRESS OF
a H YH4 HTT-TaT T YdT /ADDRESS OF PARENTS AT THE TIME OF
BIRTH OF THE CHILD: 239. GALI NO.7.
239. GALI NO.7 AMARNAGAR, FARIDABAD, FARIDABAD, FARIDABAD,
AMARNAGAR. FARIDABAD, FARIDABAD. FARIDABAD.
HARYANA
HARYANA

yslaU AE DATE OF REGISTRATION:

usU HGUT | REGISTRATION NUMBER: 13-01-2024
B-2024: 6-90192-000065

fqui REMARKS (IF ANY):

Gt arI uartt / ISSUING AUTHORITY

SI à fat/ DATE OF ISSUE:
27-01-2024
REGISTRAR (BIRTH SDEATHbath
RSRALFaridabad
PHCPål
UPDATED ON
13-01-2024 00:00:00

"THIS IS ACOMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
"THE GOVT. OF INDIA VIDE CIRCUL AB NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS AVAI D LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES"
ENSURE REGISTRATION OF EVERY BIRTH AND DEATHn