1
NO.1 GOVERNMENT OF MAHARASHTRA
T-5
FORM-5
8TTT TT
DEPARTMENT OF HEALTH
UTHALSAR PRABIHAG SAMITI THE MUNICIPAL CORPORATION oF THE CITY
OF THANE
BIRTH CERTIFICATE
u t sfaf4, 1969 qT T 12/17 3uf aTTTE T TfU r t a , 2000 8/13 3 uara 3 aT. (ISSUED UNDER
SECTION 12n7 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MAHARASHTRA REGISTRATION OF BIRTHs & DEATHS RULES
2000)
THIS IS TO CERTIEY THAT THEFOLLOwING INFORMATION HAS BEEN TAKEN FROMTHE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
UTHALSAR PRABHAG SAMITI THE MUNICIPAL CORPORATION OF THE CITY OF THANE OF TAHSIL/BLOCK THANE OF DISTRICT THANE OF STATE/UNION
TERRITORY MAHARASHTRA, INDIA.
T /NAME: LISA LUCKY DANDEKAR T 76 ais T /SEX: HtT/FEMALE
I DATE OF BIRTH: f o n PLACE OF BIRTH:
01-02-2019 KAUSHALYA MEDICAL FOUNDATION TRUST HOSPITAL
FIRST-FEBRUARY-TWO THOUSAND NINETEEN
T T T NAME OF MOTHER afsai d arT /NAME OF FATHER:
HAZEL LUCKY DANDEKAR FT TIS LUCKY DIDP DANDEKART TTY TTST
3TTR T / MOTHERs AADHAAR No: 3ATeTT T FATHER'S AADHAAR NO:
XXXXK7411
XXOOK0349
T T I A T 3TETSHiT TAT ADDRESS OF PARENTS AT THE TIME 3Tf-afsiT T4HT TV PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
B3/501, DEVDARSHAN PHASE 2 SOCIETY, G.B.ROAD B/3/ S01, DEVDARSHAN PHASE 2 soCIETY, G.B.ROAD,
WAGHBIL NAKA. THANE, THANE, THANE, WAGHBIL NAKA, THANE, THANE, THANE,
MAHARASHTRA 400615 MAHARASHTRA- 4006 15
Tei TOI, aIu T), 3T, 3Tu, araia ST, ar . ) , 3u, 3r,
6RTE400615 HRTg 400615
iT REGISIRATION NUMBER:
B-2019:27-90415-000150
vi f
14-02-2019
DATE OF REGISTRATION:
TREMARKS (IF ANY):
wroya ferANT A IDATE OF ISSUE: i a r rart HrfernrAt/ IssUING AUTHORITY
24-12-2019
sUB-REGISTRAR (BIRTH &DEATE)
UTHALSAR PRABHAG SAMITI THEMUNICIPAL cORPORATION OF THE
CITY OF THANE
UPDATED ON:
24-12-2019 16:57:38
THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSsIMILE SIGNATURE OF THE ISSUING AUTHORITY"
GoVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
THE
APPROVED THIS CERTIFICATE ASA VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES".
a zt taTN aT T ENSURE REaISTRATION OF EVERY BRTHAND DEATH"