Ys\½}FORM - 5

ȤkK^hSd^Dh^
GOVERNMENT OF GUJARAT
8^sƊ]7WpXˆ^ah^Dƣ]hRia[hF
DEPARTMENT OF HEALTH AND FAMILY WELFARE

Kƛ\̆\hRX́
BIRTH CERTIFICATE
Kƛ\7Wp\^RWҭVRj7iViW]\y~WjD_\yzy7Wp
. ȤkK^hSKƛ\\^RWҭVRjiW]\szxy€WhiW]\€ȺkKZ 
(Issued under Section 12/17 of the Registration of Birth and Death Act,1969
and Rule 8 of the Gujarat Registration of Birth and Deaths Rules 2018)

8Tj̆\hRjSD^ah\h58apJpD°WjIpWj\hˆeSjKƛ\WhȺl`^°DP½\h5Tj_pah\h58ajJpȐ[h^SWhȤkK^hS^hԌ]WhaPsU^h‰Kƣ_hWh
aPsU^hShɀkDhWhbj]hZhF˴h\be°^Wh^‰KƨN^\h5Jp

This is to certify that the following information has been taken from the original record of birth which is in the register for Village/City
SIYABAUG - North Zone of Taluka Vadodara(C) of District Vadodara of Gujarat State, India.

Wh\Name : i\ƧNŽMISHTI ĤiSSex : Ḛṏ‫ڦ‬Female

Kƛ\Sh^ŽEDate of Birth : 25/02/2024 Kƛ\ƨT`Place of Birth :

Sunday, February 25, 2024 SIR SAYAJIRAO GENERAL HOSPITAL VADODARA

\hShȵk5Wh\Name of Mother : iXShȵk5Wh\Name of Father :

‫ڤڟڝ‬᷷VARSHA iW‡E_Ȣk\h^[h^Ž̃ahKNIKHILKUMAR BHARIDRVAJ

Zh`DWhKƛ\d\]p\hShiXShȵk5d^WhȺk5Address of parents \hShiXShȵk5Dh]\jd^WhȺk5Permanent Address of

at the time of Birth of child : Parents :
31,VITHHAL NAGAR NEAR PANCHSIL MANEJA VADODARA 31,VITHHAL NAGAR NEAR PANCHSIL MANEJA VADODARA
/ ‫ڝڥڵڷ‬ḅ‫ڬڎڤژڬڠڤڔڛڦڞڅٱڔښڂړڛڋ‬ἒ‫ڤښڑگڌڝ‬ ‫ڝڥڵڷ‬ḅ‫ڬڎڤژڬڠڤڔڛڦڞڅٱڔښڂړڛڋ‬ἒ‫ڤښڑگڌڝ‬

WҭVRj˲\h5DRegistration No. : 1002 WҭVRjWjSh^ŽERegistration Date : 20/03/2024

^Ž\hD½d iabpcWҭV Remarks (if any) : ̆\hRX́W5Z^Certificate No. : B202420237177

/0

̆\hRX́DhQŽ8Ɯ]hWjSh^ŽEDate of issue : ̆\hRX́8XWh^dĂhiVDh^ŽWjdeŽSignature of Issuing

Authority :
20/03/2024 ..................................................................................

Sub Registrar ( Birth & Death )

dZ^‰Kƨ˼h^ Kƛ\\^R
SIYABAUG - North Zone , Vadodara

..

Disclaimer : This is a computer generated extract of birth register. In case of any objection, please contact concerned Registrar (B&D).
/CH+XzY3cimJPFsNnG4YKr7Sm1ZJtBHiIVA02r06BVsClH14oqOnHVAwgb43cp/T