सं.

1 उर देश सरकार प-5

NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5

चकसा एवं वाय वभाग DEPARTMENT OF MEDICAL AND HEALTH

ाम पंचायत जलपुरा

GRAMA PANCHAYAT JALPURA

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 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 UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002)

यह मािणत कया जाता है ननलिखत सुचना जम के मूल अभलेख से ल गई है जो क ाम पंचायत जलपुरा तहसील दादर िजला गौतम बु नगर
राय/संघ देश उर देश, 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 GRAMA PANCHAYAT JALPURA OF TAHSIL/BLOCK DADRI OF DISTRICT GAUTAM BUDDHA NAGAR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

नाम / NAME: M D ALAMIN लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:

जम थान/ PLACE OF BIRTH:
01-01-1991
NOIDA
FIRST-JANUARY-ONE THOUSAND NINE HUNDRED NINETY ONE

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

JAHERA BEGUM M D KASIM

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 TIME माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
PRADHAN JI WALI GALI, PRADHAN JI WALI GALI,
GEJHA SECTOR-93, NOIDA, , DADRI, GAUTAM BUDDHA NAGAR, UTTAR PRADESH GEJHA SECTOR-93, NOIDA, DADRI, GAUTAM BUDDHA NAGAR,
UTTAR PRADESH

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

B-2018: 9-05813-000143 22-12-2018

टपणी / REMARKS (IF ANY):

BY SDM ORDER

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
30-12-2018
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत जलपुरा
GRAMA PANCHAYAT JALPURA

UPDATED ON :
30-12-2018 15:29:44

"THIS IS A COMPUTER GENERATED CERTIFICATE. "

" 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 "