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FORM NO.5
(See Rule 13)

GOVERNMENT OF ANDHRA PRADESH

DEPARTMENT OF MEDICAL &HEALTH SERVICES(VITALSTATISTICS)

CERTIFICATE OF BIRTH
Issued under Section l17 of the Registration of Births and Deaths Act. 1969

This Is to certity that the following information has been taken from the original record of births which is in the
register for of Municipal Corporation, VJAYAWADA of District KRISHNA of Siate ANDHRA PRADESH
2005

1.
REGISTRATION NO. 579

2 1
DATE OF REGISTRATION 16 NOVEMBER 2005

DATE OF BIRTH 04 NOVEMBER 2005

4
SEX
Male
5.
NAME GUBBA YASODHAR

PLACE OF BIRTH ANURAG HOSPITALS

VIJAYAWADA, KRISHNA DISTRICT,ANDHFA PRADESH

NAME OF THE FATHER GUBBA ESWAR KUMAR

NAME OF THE MOTHER GUBBA HIMA BINDU

PREPARED
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COMPARED BY OUR YAKBSAT WO

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DATE
REGISTRAR OF BIRTHS &DEATHS

SEAL Corpo Otion

Vi MUNICIPAL CORPORATION, VIJAYAWADA