Certificate No.
1BF/16H / IAQ/31511                                                                          Form - 5
    •                                    GOVERNMENT OF MAHARASHTRA
          e       •
                                                HEALTH DEPARTMENT
                                             Karad Municipal Council Karad
    (Issued under section 12/17 of the Registration of Births & Deaths Act, 1969 and Rule 8/13 of the Maharashtra
  Registration of Births and Deaths RuIes,2000.)
    This is to certify that the following information has been taken from the original record of birth which is the register
  for Karad Municipal Council Karad, Karad of Tahsil / Karad of District Satara of Maharashtra State.
                      अक्षता
 Name of child: AKSHATA                                       Sex :   FEMALE
              :       २८-११-२००४
 Date of Birth:       28-11-2004                               Place of Birth: Kottage Hospital – Karad
 आई चे पूर्ण नाव :- सारिका संजय चौगुले                                          वडीलांचे पूर्ण नाव :- संजय शेलार चौगुले
 Name of Mother :- SARIKA SANJAY CHOUGULE                     Name of Father :- SANJAY SHELAR CHOUGULE
 बाळाच्या जन्माचे वेळी आई वडिलांचापत्ता :-                     आई वडिलांचा कायमचा पत्ता:
 मु.पो.कार्वे नाका ता.कराड जि.सातारा                                                         मु.पो. कार्वे नाका ता. कराड
जि.सातारा
 Address of parents at the time of birth of the child:         Permanent Address of Parents:
 A.P. KARVENAKA TAL. KARAD DIS. SATARA                         A.P. KARVENAKA TAL. KARAD DIS. SATARA
 नोंदणी क्रमांक :-      ३६१८                                                               नोंदणी दिनांक :-            २८-१२-
२००४
 Registration No :- 3618                                       Date of Registration :- 28-11-2004
 शेरा/Remarks (if any) :-
 प्रमाणपत्र दिल्यास दिनांक:-२५-०७-२०२१     ११:५६:५४
 Date of issue of certificate: 25 07-2021 11:56:54
                                                                            Signature of the issuing authority
                                                                            Registrar of Birth & Death / Chief Officer,
                                                                            Karad Municipal Council, Karad
 "Ensure Registration of évery birth & death"