థ෩ච§° Form - 5

ఒකბజఒళ౽ბబ

GOVERNMENT OF KARNATAKA
ఙథథపൡ౨పబఠఔయ෨ఓ౲ඣైంణ൏ඌ౽คఔำ
Chief Registrar of Births and Deaths
ఙథథద౳෥ఠదడ౳
‡ఙపඣైఄඌඛఫప~¬´±´బ¬­Ž¬²ඡఫద౳ఒబఠ๻ಟఒఙపඣైඛఫపఔำ~
¬´´´బඛఫప³Ž¬®బ෬ฉಡಆఞมణˆ
BIRTH CERTIFICATE
(Issued Under Section 12/17 of the RBDAct, 1969 and Rule 8/13 of the KRBD Rules, 1999)
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IUUc2X2T®eSZi^¡eC¬lĵ2SŸl’lShli_ѬeĖ¡lĶ2SVΨeĥsBĸc¬eĖ¡l
This is to certify that the following information has been taken from the original record of birth which is the register for
Hosakote
(village/town) of Bengaluru Rural taluk of Bengaluru district of Karnataka State
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Name M VIJAY Sex Male

 IUU®eSŸeĸsCh  IUU®eScÄ_ HOSAKOTE GOVT

13/12/2013
HOSPITAL,
Date of Birth Place of Birth Bengaluru, Rural Karnataka
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BHARATHI
Name of Mother Name of Father MUNEPPA

 ZDhĻUIUUScZ[SĹÐQx¡lŸeĵ[\Ļ­ec  Qx¡lŸeĵ[\‘e[xĻ­ec


Address of parents at the time of birth of the child:
THAVATAHALLI HOSAKOTE,
BANGALORE RURAL 562114
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Registration No.:
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Remarks(if any)
 VΨePVQΐliNh`¤eÎĩeĸ[cĿ
Signature of Issuing Authority
Permanent address of parents:
Thavatahalli Hosakote Bangalore Rural
562114
803162/B/B/2018/060654  £lisxSĥŸeĸsCh 09/01/2014
Date of Registration:
 4UhūsS£l[Ĩ£e2B 28/09/2014
Date of Approval
 VΨePVQΐliNh`¤eÎĩeĸ[Ļ­ec
Address of the issuing authority Medical Officer
Hosakote , Bengaluru Rural Hosakote Taluk, Bengaluru District

Date of Issue 26/11/2014

”ద౳ൟ෽ంൿఙథథపൡ౨పబఠణඣైంణ൐ఫඝ౬ఓ೉డదല๭ಆั౶ •
³Ensure registration of every birth and death´
లฃ€ఙథథඣైంణ൐ఫඝ౬https://ejanma.karnataka.gov.in ణย౵ඁുైఒค๭ಆั౶
Note: Verify the Birth registration at https://ejanma.karnataka.gov.in