उर दे श सरकार
सं . 1 GOVERNMENT OF UTTAR PRADESH
No. 1 िचिकसा एवं वाय िवभाग प-5
DEPARTMENT OF MEDICAL AND HEALTH FORM-5
नगर पािलका पिरषद गाजीपुर
NAGAR PALIKA PARISHAD GHAZIPUR
जम माण-प
BIRTH CERTIFICATE
(जम मृ यु रिजट ीकरण अिधिनयम, 1969 की धारा 12 / 17 तथा उर दे श जम मृ यु रिजट ीकरण िनयम, 2002 के िनयम 8/13 के अं तगत जारी ि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.)
(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.)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE
REGISTER FOR NAGAR PALIKA PARISHAD GHAZIPUR OF TAHSIL/BLOCK GHAZIPUR OF DISTRICT GHAZIPUR OF STATE/UNION TERRITORY
UTTAR PRADESH, INDIA.
नाम / NAME : SIMRAN YADAV
आधार सं या /AADHAR NO:
िलं ग / SEX : FEMALE
XXXXXXXX7553
जम ितिथ / DATE OF BIRTH:
11-06-2011
ELEVEN -JUNE-TWO THOUSAND ELEVEN
जम थान / PLACE OF BIRTH :
NAGAR PALIKA PARISHAD GHAZIPUR
माता का नाम / NAME OF MOTHER:
SAROJ
िपता का नाम / NAME OF FATHER :
JAIPRAKASH
आधार सं या / MOTHERS AADHAAR NO :
XXXXXXXX8433
आधार सं या / FATHERS AADHAAR NO:
XXXXXXXX7012
बचे के जम के समय माता-िपता का पता / ADDRESS OF PARENTS AT THE TIME OF
BIRTH OF THE CHILD :
माता-िपता के थायी पता / PERMANENT ADDRESS OF PARENTS:
VILL- SAVITAPUR POST - JOGAMUSAHIB THASIL - MOHAMMDABAD DIST -
VILL- SAVITAPUR POST - JOGAMUSAHIB THASIL -
GHAZIPUR PIN CODE - 233225
MOHAMMDABAD DIST - GHAZIPUR PIN CODE - 233225
पं जीकरण सं या / REGISTRATION NUMBER:
पं जीकरण तारीख / DATE OF REGISTRATION:
B-2024: 9-90347-005011
16-05-2024
िटपणी / REMARKS (IF ANY):
---
जारी करने वाला ािधकारी / ISSUING AUTHORITY :
जारी करने की ितिथ / DATE OF ISSUE :
17-05-2024 रिजटार (जम एवं मृ यु )
REGISTRAR (BIRTH & DEATH)
NAGAR PALIKA PARISHAD GHAZIPUR
NAGAR PALIKA PARISHAD GHAZIPUR
UPDATED ON :
16-05-24 01:23:06
"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".
" ये क जम एवं मृ यु का पं जीकरण सु िनिचत कर / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "
