Form-5 GOVERNMENT OF WEST BENGAL DEPARTMENT OF HEALTH AND FAMILY WELFARE KOLKATA MUNICIPAL CORPORATION BIRTH CERTIFICATE (ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL REGISTRATION OF BIRTHS & DEATHS RULES 2000.) THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR KOLKATA MUNICIPAL CORPORATION OF BLOCKIMUNICIPALITY BOROUGH 12 OF DISTRICT KOLKATA OF STATE WEST BENGAL, INDIA. NAME [AANJANEYA ROY GENDER MALE DATE OF BIRTH 9rt112023 PLACE OF BIRTH MEDICA SUPERSPECIALITY HOSPITAL, BOROUGH 12, KOLKATA, WEST BENGAL NAME OF MOTHER, MouMITA DUTTA, NAME OF FATHER, MADHUSUDAN ROY MOTHER'S IDENTITY PROOF: AADHAAR- FATHER'S IDENTITY PROOF: AADHAAR- 300000040878 YOOOOXXXT77S PRESENT ADDRESS OF MOTHER STREETILANE--490/9 SHYAMNAGAR ROAD UNITED CLUB P.O-BANGUR AT THE TIME BIRTH OF THE AVENUE DUMDUM, VILLAGE/TOWN:- KOLKATA KOLKATA MUNICIPAL CORPORATION. CHILD MUNICIPALITY DIST:- KOLKATA,WEST BENGAL-700055 PERMANENT ADDRESS OF STREET/LANE--490/9 SHYAMNAGAR ROAD UNITED CLUB,P.O-8ANGUR MOTHER ‘AVENUE, DUMDUM VILLAGETOWN.- KOLKATA KOLKATA MUNICIPAL CORPORATION. MUNICIPALITY, DIST:- KOLKATA WEST BENGAL -700055 CERTIFICATE NO 1202311435113 DATE OF REGISTRATION: 11/12/2023 S-UHID 5845904879987 REMARKS (IF ANY) DATE OF ISSUE swt2re023 UDIN = UPDATED ON 2028-11-17 18:57:49 ISSUING AUTHORITY : Signature vai oan mee fn Saris Sete SUB-REGISTRAR (BIRTH & DEATH) KOLKATA MUNICIPAL CORPORATION “THIS ($A COMPUTER GENERATED CERTIFICATE THE GOVTOF INDIA VIDE CIRCULAR NO. 17 12 014 - 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*© mie Form-5 GOVERNMENT OF WEST BENGAL DEPARTMENT OF HEALTH AND FAMILY WELFARE. KOLKATA MUNICIPAL CORPORATION BIRTH CERTIFICATE, (ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL REGISTRATION OF BIRTHS & DEATHS RULES 2000.) ‘THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS ‘THE REGISTER FOR KOLKATA MUNICIPAL CORPORATION OF BLOCK/MUNICIPALITY BOROUGH 12 OF DISTRICT KOLKATA OF STATE WEST BENGAL, INDIA. NAME: [AANJANEYA ROY GENDER Mae DATE OF BIRTH 09172023 PLACE OF BIRTH MEDICA SUPERSPECIALITY HOSPITAL, BOROUGH 12, KOLKATA, WEST BENGAL NAME OF MOTHER MOUMITA DUTTA, NAME OF FATHER : MADHUSUDAN ROY MOTHER'S IDENTITY PROOF: AADHAAR- FATHER'S IDENTITY PROOF ; AADHAAR- 300000000878 XOOOOOXTITE PRESENT ADDRESS OF MOTHER STREET/LANE:- 49019 SHYAMNAGAR ROAD UNITED CLUB,P.O-BANGUR AT THE TIME BIRTH OF THE AVENUE, DUMDUM, VILLAGE/TOWN:- KOLKATAKOLKATA MUNICIPAL CORPORATION CHILD MUNICIPALITY.DIST:- KOLKATA WEST BENGAL-700085 PERMANENT ADDRESS OF 'STREETILANE:- 490/9 SHYAMNAGAR ROAD.UNTED CLUS,P.O-BANGUR MOTHER ‘AVENUE, OUMDUM, VILLAGE/TOWN:- KOLKATA KOLKATA MUNICIPAL CORPORATION MUNICIPALITY,DIST:- KOLKATAWEST BENGAL-700055 CERTIFICATE NO erozaia35113 DATE OF REGISTRATION; 11/12/2023 S-UHID 5459040799873, REMARKS (IF ANY) DATE OF ISSUE rz von UPDATED ON 2023-11-17 158749 ISSUING AUTHORITY : Sonate vol eric Serge we sSee SUB-REGISTRAR (BIRTH & DEATH) KOLKATA MUNICIPAL CORPORATION "THIS 1S 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 SSURE REGISTRATION OF EVERY BIRTH AND DEATH"