Form-5
GOVERNMENT OF WEST BENGAL
DEPARTMENT OF HEALTH AND FAMILY WELFARE
GRAM PANCHAYET UTTAR CHANDIPUR
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 AAA OF TAHSIL/BLOCK BBB OF DISTRICT CCC OF STATE/UNION TERRITORY DDD, INDIA.
NAME : NIRMAL ZEET SINGH GENDER : MALE
DATE OF DEATH : 19-04-1995 PLACE OF DEATH : SUB DIVISION HOSPITAL CANNING
AGE OF DECEASED : 61 YEAR NAME OF SPOUSE : uma debi singh
IDENTITY PROOF : XXNA
NAME OF MOTHER : RASHMI DEBI SINGH NAME OF FATHER : HARICHARAN ZEET SINGH
MOTHERS IDENTITY PROOF : XXXXXXXXXXNA FATHERS IDENTITY PROOF : XXXXXXXXXXNA
ADDRESS OF THE DECEASED
AT THE TIME OF THE 46 INDIAN MIRROR STREET KOLKATA WEST BNEGAL 700013
DEATH :
PERMANENT ADDRESS OF
46 INDIAN MIRROR STREET KOLKATA WEST BNEGAL 700013
DECEASED :
CERTIFICATE NO : D-2024: 10-90347-00696 DATE OF REGISTRATION : 31-01-2003
S-UHID : 98870991528534 REMARKS (IF ANY) :
DATE OF ISSUE : 31-01-2003 ISSUING AUTHORITY :
UPDATED ON : 01-06-2024 04:58:37
Signature Valid
Digitally Signed.
Name:
Date: 01-06-2024 04:58:37
REGISTRAR (BIRTH & DEATH)
SUB DIVISION HOSPITAL CANNING
"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"
