Form No.
5
(See Rule 8)
Government of Tamil Nadu
Municipal Administration & Water Supply Department
SALEM CITY MUNICIPAL CORPORATION /
BIRTH CERTIFICATE -
(Issued Under Section 12/17 of the registration of Births and Deaths Act.1969 and Rule of 8 of Tamil Nadu Registration of Birth and Death Rules 2000)
This is to Certify that the following information has been taken from the original record of BIRTH which is
in the register for WD-32 of SALEM CITY MUNICIPAL CORPORATION of Taluk SALEM NORTH of District SALEM of
State TAMIL NADU
Name / :
Sex / :
Date of Birth / : 09/Jun/2005
Place of Birth/ :
76 1
-636001
Name of Father / :
UID Number of Father / : XXXXXXXXXXXX
Name of Mother/ :
UID Number of Mother/ : XXXXXXXXXXXX
Permanent Residential Address of the Parents / :
Address of the Parents at the time of Birth of the Child / : ,
Registration Number / : 049/2005/32/00641
Date of Registration / : 09/Jun/2005
Remarks(If any) / :
Date of Issue / : 23/Nov/2024
Signature and Address of Issuing Authority
Registrar, Birth & Death:
Ensure Registration Of Every Birth And Death
Certificate No : BCP/049/2024/0055459
Note:This Certificate is computer generated and does not require any seal/signature the authenticity of this certificate can be verified
https:// tnurbanepay.tn.gov.in .The Registration number is unique to each Birth.
