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This document is a birth certificate issued by the Government of Uttar Pradesh for Ashirvad Shukla, born on September 10, 2009, at Primary Health Centre Devataha. It includes details such as the names of the parents, their addresses, and the registration number and date. The certificate is recognized as a valid legal document for official purposes, as per government regulations.

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Santosh Shukla
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43 views1 page

2 1 PDF

This document is a birth certificate issued by the Government of Uttar Pradesh for Ashirvad Shukla, born on September 10, 2009, at Primary Health Centre Devataha. It includes details such as the names of the parents, their addresses, and the registration number and date. The certificate is recognized as a valid legal document for official purposes, as per government regulations.

Uploaded by

Santosh Shukla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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सं.

1 उर देश सरकार प-5


NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाथमक वाय क देवतहा
PRIMARY HEALTH CENTRE DEVATAHA

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार 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)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क ाथमक वाय क देवतहा तहसील गडा िजला गडा राय/संघ
देश उर देश, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER
FOR PRIMARY HEALTH CENTRE DEVATAHA OF TAHSIL/BLOCK GONDA OF DISTRICT GONDA OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

नाम / NAME: ASHIRVAD SHUKLA लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:


जम थान/ PLACE OF BIRTH:
10-09-2009
PHC DEVATAHA
TENTH-SEPTEMBER-TWO THOUSAND NINE

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:


PRATIBHA SHUKLA SANTOSH ANAND SHUKLA

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
GHARUK VIRWA (PIPRA BHITAURA), IMILIYA ROOPI (VISHUNPUR BAIRIYA), GHARUK VIRWA (PIPRA BHITAURA), IMILIYA ROOPI
PANDRI KRIPAL, , GONDA , GONDA, UTTAR PRADESH- 271601 (VISHUNPUR BAIRIYA),
PANDRI KRIPAL, GONDA , GONDA,
UTTAR PRADESH- 271601

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:


B-2022: 9-58883-000079 26-04-2022

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
26-04-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाथमक वाय क देवतहा
PRIMARY HEALTH CENTRE DEVATAHA

UPDATED ON :
26-04-2022 08:21:52

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
" 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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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