Scribd
Upload
44K views1 page

Birth Certificate: Government of Uttar Pradesh

This document is a birth certificate issued by the Gram Panchayat Jani Jot in Uttar Pradesh, India. It certifies the birth of Shani Vishwakarma, born on May 3, 2016 in Siddharthnagar, Uttar Pradesh to mother Susheela and father Gaya Prasad, who resided in Pachudh, Siddharthnagar at the time. The certificate provides details such as the parents' names and addresses, the child's name and date of birth, and was issued and registered on November 23, 2021.

Uploaded by

SAGAR Gaur
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
44K views1 page

Birth Certificate: Government of Uttar Pradesh

This document is a birth certificate issued by the Gram Panchayat Jani Jot in Uttar Pradesh, India. It certifies the birth of Shani Vishwakarma, born on May 3, 2016 in Siddharthnagar, Uttar Pradesh to mother Susheela and father Gaya Prasad, who resided in Pachudh, Siddharthnagar at the time. The certificate provides details such as the parents' names and addresses, the child's name and date of birth, and was issued and registered on November 23, 2021.

Uploaded by

SAGAR Gaur
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

सं.

1 उर देश सरकार प-5


NO. 1 GOVERNMENT OF UTTAR PRADESH FORM-5
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाम पंचायत जन जोत
GRAMA PANCHAYAT JANI JOT

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया 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)

यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क ाम पंचायत जन जोत तहसील महेसी िजला बहराइच राय/संघ देश
उर देश, भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH 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: SHANI VISHWAKARMA लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH: जम थान/ PLACE OF BIRTH:


03-05-2016 SIDDHARTHNAGAR,
THIRD-MAY-TWO THOUSAND SIXTEEN JANIJOT,MAHASI, BAHRAICH,
UTTAR PRADESH

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER:


SUSHEELA GAYA PRASAD

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX1343
XXXXXXXX1944

बचे के जम 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 संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:


B-2021: 9-32717-001143 23-11-2021

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
23-11-2021
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत जन जोत
GRAMA PANCHAYAT JANI JOT

UPDATED ON :
23-11-2021 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".

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

You might also like