Form-5
GOVERNMENT OF WEST BENGAL
                              DEPARTMENT OF HEALTH AND FAMILY WELFARE
                                        HOWRAH DISTRICT HOSPITAL
                                              BIRTH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST
BENGAL
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH
WHICH IS THE REGISTER FOR HOWRAH DISTRICT HOSPITAL OF TAHSIL/BLOCK HOWRAH OF DISTRICT HOWRAH OF
STATE/UNION TERRITORY WEST BENGAL , INDIA.
NAME :                              TARAK SARKAR          GENDER :                   MALE
DATE OF BIRTH :                     02-01-1977            PLACE OF BIRTH :           HOWRAH DISTRICT HOSPITAL
NAME OF MOTHER :                    RINA SARKAR           NAME OF FATHER :           GOPAL SARKAR
MOTHERS IDENTITY PROOF :            XXXXXXXXXXNA FATHERS IDENTITY PROOF : XXXXXXXXNA
PRESENT ADDRESS OF MOTHER
AT THE TIME BIRTH OF THE            21/1 MUKHERJEE PARA ROAD BHATPARA NORTH 24 PGS WEST EBNGAL 743123
CHILD :
PERMANENT ADDRESS OF
                                    21/1 MUKHERJEE PARA ROAD BHATPARA NORTH 24 PGS WEST EBNGAL 743123
MOTHER :
CERTIFICATE NO :                    B/202473196           DATE OF REGISTRATION :     15-10-2013
S-UHID :                            98870991721340        REMARKS (IF ANY) :
DATE OF ISSUE :                     15-10-2013            ISSUING AUTHORITY :
UPDATED ON :                        03-06-2024 06:45:17
                                                                                Signature Valid
                                                                                Digitally Signed.
                                                                                Name: SADIQUE KHAN
                                                                                Date: 03-06-2024 06:45:17
                                                                                REGISTRAR (BIRTH & DEATH)
                                                                                HOWRAH DISTRICT HOSPITAL
                               "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
                             "ENSURE REGISTRATION OF EVERY BIRTH AND DEATH"