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INDIA NON JUDICIAL I N U P 0 0 0 1 6 ) 7 0 5 1 9 2 7 X
KAJU P A l E L s
Government of Uttar Pradesh ACC
UP 145 o4
to
Kutd,ry
No.-769
e-Stamp LIC Sadar, Prarr
wasaa Ncb-7668577700.3dtas40
IN UPZO001637051927X
Certiflcate No.
31Ma-2025 12:21 PM PRAYAGnAJ
SADARV UP-AHD
Cotificate Issued Date upt4513004/
NEWINPACO (SVW
Account Reterence : sUON-UPUP 145130043839:3593407104X
Unique Dx, Reference
Dn UIMILA DEVI
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O R A L : N O T
Second Party : DR URMILA DEVI
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httys:/nextgen.eospital.gov.in'registration'new registrationre
Tej Bahadur Sapru
Stanley Road Hospital
Allahabad Uttar Pradesh
es H1 (Registration
No) : 2025o058419
R(Visit No): 1/
In (oom No) : Main iim (Token No) :G
Building,OPD 9lock, Graund,4B, 5.6
Paediatrics OPD
OUT PATIENT RECORD
Nane): Mr. Achut Singh
H(Age Sex) : 13Y / M ttallazu uf (Registration Amount): Rs. 1
Department) : Paediatrics itqigt tr (Mobille No) : ses*471
ll (Address) :A,PRAYAGRAJ(UTTAR PRADESH)
loru fafà (Date of Registration) :31/03/2025
oR (Patient Type) : General 09.21 AM
(Guardian Name) : SUDHEER KUMAR SINGH(Father) MLC Patient: NO
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Pem 20
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rest Jan Aushadhi Kendras:1.TB Sapru Hospital, Stanly road
538A 8, Ground Floor, Katra
Ared By: Mr, Nilesh Tiwari Date Time: 31/03/2025 09.21 AM
Achyt Sgh
nAhDOR ZA0A/2012
ETMaie
5369 5721 4728
Uolque kdentiication Authunty of lndha
$FZ, 3 u, 211019
Asdress: co Sudhir Kumar Sngh
10/116 Awas Viaas Colony Scheme-3
Behind Ganga Polution Control Board,
Jhunsi, Allahabad, Uttar Pradesh, 211019
5369 5721 4728
T1947 helpGuldal.gov.in t www.uldal. gov.in