सं.
1 सरकार
-5
NO. 1 GOVERNMENT OF UTTAR
PRADESH FORM-5
सावं
ए वा
य
DEPARTMENT OF MEDICAL
AND HEALTH
पंचायत जन जोत
GRAMA PANCHAYAT
JANI JOT
म माण-
DEATH
CERTIFICATE
( , 1969 क धारा 12 / 17 , 2002 नयम 8/13 अं
तजार कया
ग
त
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)
ज
मके
मूल अभलेख से ल गई है जो क ाम पंचायत जन जोत तहसील महेसी
बहराइच राय/ देश
, रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE
ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR
GRAMA PANCHAYAT JANI JOT OF TAHSIL/BLOCK MAHASI OF DISTRICT BAHRAICH OF
STATE/UNION TERRITORY UTTAR PRADESH, INDIA.
नाम / NAME: KASHMIR SINGH
लंग / SEX: / MALE
/ DATE OF DEATH:
/ PLACE OF DEATH:
03-05-1952
SIDDHARTHNAGAR,
JANIJOT,BAHERI, BAREILLY,
UTTAR PRADESH
माता का नाम / NAME OF MOTHER:
पता का नाम / NAME OF FATHER:
HARNAM KAUR
SARDARA SINGH
आधार नंबर / MOTHER'S AADHAAR NO:
आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX1343
XXXXXXXX1944
जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME OF
माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
BIRTH OF THE CHILD:
PACHUDH,
PACHUDH,
AUDAHI KALA, AUDAHI, , SHOHRATGARH, SIDDHARTHNAGAR, UTTAR PRADESH-
AUDAHI KALA, AUDAHI, SHOHRATGARH, SIDDHARTHNAGAR,
272201
UTTAR PRADESH- 272201
पंजीकरण संया / REGISTRATION NUMBER:
पंजीकरण तारख / DATE OF DEATH:
B-2021: 9-32717-001143
25-07-2025
टपणी / REMARKS (IF ANY):
---
जार करने क तथ / DATE OF ISSUE:
/ ISSUING AUTHORITY :
08-08-2025
ार
( मृयु)
REGISTRAR (BIRTH & DEATH)
पंचायत जन जोत
GRAMA PANCHAYAT JANI JOT
UPDATED ON :
08-08-2025 16:33:41
"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".
" पंजीकरण सुनचत कर" / ENSURE REGISTRATION
OF EVERY BIRTH AND DEATH "
