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Government of
Na ti onal Capital Territory of Delhi
Municipal Corporation of Otlhl
490512
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INDlA

q;l1f <IBQT/ FORM NO. 5

(F-1,r,i mlU1 8 ffilni)/(S,e R11l,-8)

lfl!TVJ*~l~RTI Fl CATE
(""" 'I'! 'll'9 amlf."'1, 1969 um -di 3R!'ffl It'll Tf111)
(Issued under scc1i¡I? of 1he Rcgis1rn1ionof Binhs and Dea1hs Ac1, 1969)

<ll'~~=t~~~'l<'l<ffl~~TJ"(tlir
This is 10 certify lha1 the following mforma1ion has been IBken from 1hc original record of BIRTH

>f t ("""11,i ffll) S H S O U T It Z O N Office S ff': S O U T H

which 1s rcg1s1crfor (Local Arca) zo NE of Zone of

'l"R f.l'lll -di ii'; 'll. 'It. n. I

Municipal Corporation of Delhi of Disuic1 Llothi
ofNCT of Delhi.

'11'1 /Namc:

r.i>i /GenderFemai<>

ªii /Da te 0 h1rth 25/011:!007

1'IR /Pince ~'1h PUSHPANUALI NURSING HOME A-14-15 PUSPANJALI \111<'.ASHMI\RG EXTENSICi, N!::V,
DELHI
1111 fllfr/ /Dale ofRegistrauon
30/01/2C07
ffl!lll /Registra1ion J\o ..
MCOOLR07026097

Name o f Motiier KJRAN

Name o f Father KA M A L

l-"
Present Address

Permanen!Address '" I
q-\1\)<liWS\I. "'

~ii~-~ ~:lpe
.~ ti~~-~ 11,ps
1 1 / 1 1 /2 0 1 0 8/Sh South ZoneMiS,,b ·Rtiti~l,ttrar of Birth & ~eath
fllft) / Daic. 11m/Scal: MunicipalCorporalion of Delhi

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