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Birth Certificate: Government of Uttar Pradesh

This document is a birth certificate for Afsana Khatoon born on December 10th, 2003 in Nai Basti Uttar Tola Banki Tehsil Nawabganj Barabanki UP, India. It provides details about her parents - mother Naseema Khatoon and father Mohd Shakir. It also lists the registration number and date, as well as the address of her parents at birth and currently. The issuing authority is the Registrar of Births and Deaths of Grama Panchayat Atwatmau.

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Er. Ravi Jaiswal
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2K views1 page

Birth Certificate: Government of Uttar Pradesh

This document is a birth certificate for Afsana Khatoon born on December 10th, 2003 in Nai Basti Uttar Tola Banki Tehsil Nawabganj Barabanki UP, India. It provides details about her parents - mother Naseema Khatoon and father Mohd Shakir. It also lists the registration number and date, as well as the address of her parents at birth and currently. The issuing authority is the Registrar of Births and Deaths of Grama Panchayat Atwatmau.

Uploaded by

Er. Ravi Jaiswal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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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 अवटमउ
GRAMA PANCHAYAT ATWATMAU

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 अवटमउ तहसील नवाबगंज िजला बाराबंक
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 ATWATMAU OF TAHSIL/BLOCK NAWABGANJ OF DISTRICT BARA BANKI OF STATE/UNION TERRITORY UTTAR PRADESH,
INDIA.

नाम / NAME: AFSANA KHATOON लंग / SEX: महला / FEMALE

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


10-12-2003 NAI BASTI UTTAR TOLA BANKI TEH NAWABGANJ BARABANKI UP
TENTH-DECEMBER-TWO THOUSAND THREE 225001

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


NASEEMA KHATOON MOHD SHAKIR

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

XXXXXXXX7802

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
TIME OF BIRTH OF THE CHILD: NAI BASTI UTTAR TOLA BANKI TEH NAWABGANJ BARABANKI UP
NAI BASTI UTTAR TOLA BANKI TEH NAWABGANJ BARABANKI UP 225001 225001

पंजीकरण संया / REGISTRATION NUMBER: पंजीकरण तारख / DATE OF REGISTRATION:


B-2021: 9-29312-000049 31-07-2021

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
31-07-2021
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत अवटमउ
GRAMA PANCHAYAT ATWATMAU

UPDATED ON :
31-07-2021 12:31:46

"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 "

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