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सं.

1 बहार सरकार प-5


NO. 1 GOVERNMENT OF BIHAR FORM-5
योजना और वकास वभाग
DEPARTMENT OF PLANNING AND DEVELOPMENT
सदर अपताल मधुबनी
SADAR HOSPITAL MADHUBANI

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा बहार जम मृयु रिजकरण नयम, 1999 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 BIHAR REGISTRATION OF
BIRTHS & DEATHS RULES 1999)
यह मािणत कया जाता है ननलिखत सूचना जम के मूल अभलेख से ल गई है जो क सदर अपताल मधुबनी तहसील मधुबनी िजला मधुबनी
राय/संघ देश बहार, 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 SADAR HOSPITAL MADHUBANI OF TAHSIL/BLOCK MADHUBANI OF DISTRICT MADHUBANI OF STATE/UNION TERRITORY BIHAR, INDIA.

नाम / NAME: MEDHANSH THAKUR लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:


जम थान/ PLACE OF BIRTH:
30-07-2022
SADAR HOSPITAL MADHUBANI
THIRTIETH-JULY-TWO THOUSAND TWENTY TWO

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


NEHA KUMARI MUKESH KUMAR THAKUR

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

XXXXXXXX7923

बचे के जम के समय माता-पता का पता / ADDRESS OF PARENTS AT THE TIME माता-पता के थायी पता/ PERMANENT ADDRESS OF PARENTS:
OF BIRTH OF THE CHILD:
BIJALPURA, BIJALPURA,
LOHA, BIJALPURA, , BENIPATTI, MADHUBANI, BIHAR LOHA, BIJALPURA, BENIPATTI, MADHUBANI,
BIHAR

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


B-2022: 10-90268-003221 19-09-2022

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
19-09-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
सदर अपताल मधुबनी
SADAR HOSPITAL MADHUBANI

UPDATED ON :
19-09-2022 13:12:27

"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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