सं.

1 झारखंड सरकार प-5

NO. 1 GOVERNMENT OF JHARKHAND FORM-5
योजना एवं वकास वभाग (अथ एवं सांियक नदेशालय)
DEPARTMENT OF ECONOMICS & STATISTICS
जमशेदपुर अधसूचत े समत
JAMSHEDPUR NOTIFIED AREA COMMITTEE

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा झारखंड जम मृयु रिजकरण नयम, 2009 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 JHARKHAND
REGISTRATION OF BIRTHS & DEATHS RULES 2009)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क जमशेदपुर अधसूचत े समत तहसील गोलमुर-जुगसलाई
िजला पुबी संहभूम राय/संघ देश झारखंड, 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 JAMSHEDPUR NOTIFIED AREA COMMITTEE OF TAHSIL/BLOCK GOLMURI-CUM-JUGSALAI OF DISTRICT PURBI SINGHBHUM OF
STATE/UNION TERRITORY JHARKHAND, INDIA.

नाम / NAME: MOHAMMAD AREEB UDDIN लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
30-04-2022
STEEL CITY CLINIC NURSING HOME
THIRTIETH-APRIL-TWO THOUSAND TWENTY TWO

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

NAUSHABA TARANNUM SHAZADA SALIMUDDIN

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 माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
TIME OF BIRTH OF THE CHILD:
174, EDDGHA MAIDAN GOURI SHANKAR , 174, EDDGHA MAIDAN GOURI SHANKAR,
JUGSALAI, JAMSHEDPUR (NAC), , GOLMURI-CUM-JUGSALAI, PURBI JUGSALAI, JAMSHEDPUR (NAC), GOLMURI-CUM-JUGSALAI,
SINGHBHUM, JHARKHAND- 831006 PURBI SINGHBHUM,
JHARKHAND- 831006

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

B-2022: 20-90019-004125 04-05-2022

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
04-05-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
जमशेदपुर अधसूचत े समत
JAMSHEDPUR NOTIFIED AREA COMMITTEE

UPDATED ON :
04-05-2022 00:00:00

"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 "