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Book No.

~ ~W tt(~I<
Government of Uttar Pradesh
~m
S.No.
(~ ~ (~~~(UI ~ 1969 12/17 2003
f.rcfq8 ~ .. wft)
~wnur-~
. (Birth Certificate)
wrnum ~ ijfffif ~ fcfi f.1k1~r&~~ ~ ~ ~ ~ -« (iff1lt ~ ~ (~ ~)
mtf~ ~(cITt .. iJFI'QG.....................................
~ ~ ~~T t-~ ij ~ t':-
;w:r ........................................................................................................
Name

iWT ........................................................................................................
Sex.

ijfOq cor ~ ~... ~ ............


Date of Birth & Place ........................................................................................................

mcor;w:r ........................................................................................................
Name of Father

1ffi'IT.cor 'WI ........................................................................................................


Name of Mother

~~Rm ........................................................................................................

Registration No.

~~R cor ~ ........................................................................................................


Date of Registration

~:
Date:
(P1~I( ijfOq~
~ Registrar Birth & Death
Place:

~
(Seal)
H.P./9/03

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