Scribd
Upload
141 views1 page

Tue Izek.K & I K: Birth Certificate

This document is a birth certificate issued under the Registration of Births and Deaths Act, 1969, and relevant state rules. It certifies the birth details of an individual, including their name, sex, date and place of birth, and the names and addresses of their parents. The document includes registration details and is signed by the issuing authority.

Uploaded by

mw9813985
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
141 views1 page

Tue Izek.K & I K: Birth Certificate

This document is a birth certificate issued under the Registration of Births and Deaths Act, 1969, and relevant state rules. It certifies the birth details of an individual, including their name, sex, date and place of birth, and the names and addresses of their parents. The document includes registration details and is signed by the issuing authority.

Uploaded by

mw9813985
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
You are on page 1/ 1

iz:i la- 5

FORM NO. 5

tUe izek.k & i=k


BIRTH CERTIFICATE
¼ tUe vkSj e`R;q jftLVªhdj.k vf/kfu;e] 1969 dh /kkjk 12@17 vkSj
jktLFkku tUe vkSj e`R;q jftLVªhdj.k fu;e] 2000 ds fu;e 8@13 ds v/khu tkjh fd;k x;k ½
( Issued under Section 12/17 of the Registration of Births and Deaths Act,1969 and Rule 8/13 of the
Rajasthan Registration of Births and Deaths Rules, 2000 )

;g izekf.kr fd;k tkrk gS fd fuEu fyf[kr lwpuk tUe ds ewy vfHkys[k ls yh xbZ gS tks fd ¼LFkkuh; {ks=k@LFkkuh; fudk; ½ ---------------------------------
------------------------ rglhy @[k.M ------------------------------------------------------------------------------ ftyk ------------------------------------------------------------------------------------------jkT;-@la?k jkT;
{ks=k-------------------------------------------------------------dk jftLVj gSA

This is to certify that the following information has been taken from the original record of birth which is the
register for (local area / local body)………………………….of tahsil / block .………………………. of
District………………………………of state / Union territory ……………………………

uke@Name: ……………………………………….............. fyax@ Sex.................................………………………..


tUe frfFk@Date of Birth ……………………...................… tUe LFkku @Place of Birth …......................……………
ekrk dk uke@Name of Mother………………………………................................................……………………….
firk dk uke @ Name of Father…………………………….....................................................……………………….

cPps ds tUe ds le; ekrk firk dk irk ekrk&firk dk LFkk;h irk


Address of parents at the time of birth of the child: Permanent address of parents:
……………………………....…………........…… ................................………………………………..
………………………………………............…… ………………................................………………..
………………………………………............…… ……………................................…………………..

jftLVdj.k la-@Registration No:. ……………...........… jftLVªhdj.k dh rkjh[k@ Date of Registration


……............................
fVIi.kh@Remarks(if any)………......................................................................................................…………………
tkjh djus dh rkjh[k @ Date of issue:.....….................tkjhdjus okys izkf/kdkjh ds gLrk{kj@ Signature of the issuing authority

tkjhdjus okys izkf/kdkjh dk irk @ Address of the issuing authority

eqgj@Seal

You might also like