(English Version) FORM NO-5
ISSUE NO : 399/2024
GOVERNMENT OF ODISHA
DEPARTMENT OF HEALTH AND FAMILY WELFARE
KABISURYANAGAR CHC
CERTIFICATE OF BIRTH
Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and 8/13 Rule of the Odisha
Registration of Births and Deaths, Rule 2001
This is to certify that following information has been taken from the original records of birth which is in the
register for KABISURYANAGAR CHC of Tahasil KABISURYANAGAR
of District GANJAM of State ODISHA
NAME: RAJABATI PRADHAN SEX: FEMALE
DATE OF BIRTH: PLACE OF BIRTH:
03/07/1982 MATHATENTULIA, KANIARY, KABISURYANAGAR,
GANJAM, ODISHA, INDIA
NAME OF MOTHER: NAME OF FATHER:
KUNDA PRADHAN NIDHI PRADHAN
MOTHER'S ID PROOF NO: FATHER'S ID PROOF NO:
ADDRESS OF PARENT AT THE TIME OF CHILD PERMANENT ADDRESS OF PARENTS:
BIRTH:MATHATENTULIA, KANIARY, KABISURYANAGAR, MATHATENTULIA, KANIARY, KABISURYANAGAR,
GANJAM, ODISHA, INDIA GANJAM, ODISHA, INDIA
REGISTRATION NO: REGISTRATION DATE:
321/2024 22/06/2024
UBRN NO: DATE OF ISSUE:
21RB354-0145-000321-2024 22/06/2024
Signature Not Verified Dr Amaresh Sahoo
Digitally signed by AMARESH Issuing Authority
SAHOO
Date: 2024.06.22 14:14:35 IST Registrar, Births & Deaths
Reason: Birth Certificate
Location: KABISURYANAGAR KABISURYANAGAR CHC
THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY.
It is a digitally signed electronically generated certificate and therefore needs no ink-signed signature,stamp or seal. This certificate is
issued as per section 4,5 & 6 of information technology Act 2000 and it's subsequent amendments in 2008.For any query or
verification, please visit https://www.birthdeath.odisha.gov.in Tampering of this certificate will attract
penal action.