Key No.
B0020366-79042410617
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
]©mb¯v hIp¸v
DEPARTMENT OF PANCHAYAT
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv ISbv¡ð {Kma ]©mb¯v
Name of Local Government issuing certificate Kadakkal Grama Panchayat
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)
(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse sImñw Pnñbnse sIm«mc¡c Xmeq¡nse ISbv¡ð {Kma ]©mb¯v
þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local
body) Kadakkal Grama Panchayat of Taluk Kottarakara of District Kollam of State Kerala.
---t]cv/ Name : Nil
---B¬/s]¬/ Sex B¬/ Male
:
---P\\ XobXn/ Date of Birth : 16/04/1979
SIXTEEN/APRIL/ONE THOUSAND NINE HUNDRED SEVENTY NINE
---P\\ Øew/ Place of Birth :
Kh¬saâv tlmkv]näð, ISbv¡ð/
Govt. Hospital, Kadakkal
---amXmhnsâ t]cv / Name of Mother Majeeda Beevi
:
---]nXmhnsâ t]cv/ Name of Father
: Abdul Khader
Ip«nbpsS P\\ kab¯v : *** e`yañ
amXm]nXm¡fpsS taðhnemkw
Address of the parents at the time of : *** Not Available
birth of the child
amXm]nXm¡fpsS Øncamb : tcJs¸Sp¯nbn«nñ
taðhnemkw
Permanent address of parents : A.M.K. Manzil, Pallimuku
cPnkvt{Sj³ \¼À/ : 300/1979 cPnkvt{Sj³ XobXn/ : 24/04/1979
Registration Number Date of Registration
*** AÊð tcJIfnð Ip«nbpsS P\\ kab¯v amXm]nXm¡fpsS taðhnemks¯
---A`n{]mb¡pdn¸v/ Remarks (if any) : kw_Ôn¨ tImf§Ä DÄs¸Sp¶nñ
*** The original records do not contain the column relating to the address of the parents at
the time of birth of the child.
---\ðIp¶ XobXn/ Date of Issue : 12/03/2021 (20:55) Last Updated on 07/07/2014 (10:47)
\ðIp¶ A[nImcnbpsS taðhnemkw/
: Registrar of Births and Deaths ,
Address of the issuing authority
Kadakkal Grama Panchayat
“Ensure Registration of Every birth and death”
“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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