पपरप ससखखप 5

FORM NO.5
रपजससपन सरकपर
Government of Rajasthan
आरसरक एवस सपसखखखकक ननदद शपलख
Directorate of Economics & Statistics
रखजससपर - रपजककख सपमपनख रचककतसपलख हनम
न पनगढ टपऊन, हनम
न पनगढ
Registrar - GOVERNMENT GENERAL HOSPITAL HANUMANGARH TOWN, HANUMANGARH
जनम पमपण पत
BIRTH CERTIFICATE
(जनम और मतम यत रजजससलकरण अथधतनयम,1969 कक धनरन 12/17 और रनजसथनन जनम और मतम यत
रजजससलकरण तनयम, 2000 कक तनयम 8/13 कक अधयन जनरल ककयन गयन)
(Issued under Section 12/17 of the Registration of Births and Deaths Act,1969 and Rule 8/13 of the
Rajasthan Registration of Births and Deaths Rules, 2000)
यह पमनणणत ककयन जनतन हह कक तनमनललणखत ससचनन जनम कक मसल अलभलकख सक लल गयय हह जज कक (सथननयय ककत / सथननयय तनकनय) ........
तहसयल/खणण........जजलन........रनजय/सलघ रनजय........ कन रजजससर
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) GOVERNMENT GENERAL HOSPITAL HANUMANGARH TOWN of Tehsil / Block xxxx of District HANUMANGARH of State /
Union Territory Rajasthan, India .
ननम / Name : SUDIKSHA लललग / Sex : FEMALE

जनम ततथथ / Date of Birth : 21/11/2023 जनम सथनन / Place of Birth :

M.G.M. GOVT. DISTRICT HOSPITAL,
मनतन कन ननम / Name of Mother : POOJA BHATI
HANUMANGARH TOWN (RAJ.)
मनतन कन आधनर नलबर / Mother Aadhar No :********3183

पपतन कन ननम / Name of Father : SURENDER KUMAR

पपतन कन आधनर नलबर / Father Aadhar No : ********4532

बचचक कक जनम कक समय मनतन पपतन कन पतन : मनतन पपतन कन सथनयय पतन :
Address of parents at the time of birth of the child : Permanent Address of the parents :
WARD NO.11, KHERUWALA, 22 PTP A WARD NO.11, KHERUWALA, 22 PTP A
(KHAIROOWALA), GANGANAGAR, RAJASTHAN (KHAIROOWALA), GANGANAGAR,
RAJASTHAN

रजजससलकरण सलखयन / Registration No : रजजससलकरण कक तनरलख / Date of Registration :

08100001000000805695 / 2023 23/11/2023 Signature Not
Verified

टसपपणय / Remarks If Any : Digitally signed by

Vinod Kumar
Date: 2023.12.26
13:03:27 +05:30

जनरल करनक कक तनरलख Date of issue : 26/12/2023

जनरल करनक वनलक पनथधकनरल कक हसतनकर/ Signature of issuing authority

Note: Information in respect of the columns "Present address of parents at the time of birth of the child" and "Permanent address of parents" were not
applicable before 01/01/2007
Use of Digital Signature for issuing birth and death certificate is recognized by Economics and Statistics Department, Governent of Rajasthan vide
circular number F13/1/39/VS/DES/2013/22519 Dated 02.06.2015.

Software Courtesy National Information Centre (NIC), Rajasthan Certificate can be tracked on https://pehchan.raj.nic.in