Birth Certificate

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Form-5

GOVERNMENT OF WEST BENGAL


DEPARTMENT OF HEALTH AND FAMILY WELFARE

RURAL HOSPITAL RAIDIGHI

BIRTH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR RURAL HOSPITAL RAIDIGHI OF BLOCK/MUNICIPALITY MATHURAPUR - II OF DISTRICT SOUTH 24 PARGANAS
OF STATE WEST BENGAL, INDIA.

NAME : ASHA RUIDAS GENDER : FEMALE

DATE OF BIRTH : 24/10/2015 PLACE OF BIRTH : RURAL HOSPITAL RAIDIGHI,


MATHURAPUR - II, SOUTH 24 PARGANAS,
WEST BENGAL

NAME OF MOTHER : MANJUSA RUIDAS NAME OF FATHER : SAMBHU RUIDAS

MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : AADHAAR- XXXXXXXX5685


XXXXXXXX0109

PRESENT ADDRESS OF MOTHER LOCALITY:- UTTAR KANKANDIGHI, KANKANDIGHI, VILLAGE/TOWN:- KANKANDIGHI,MATHURAPUR - II


AT THE TIME BIRTH OF THE BLOCK,DIST:- SOUTH 24 PARGANAS,WEST BENGAL-743383
CHILD :

PERMANENT ADDRESS OF LOCALITY:- UTTAR SINGHER GHERI, KUMRAPARA,VILLAGE/TOWN:- KUMARAPARA,MATHURAPUR - II


MOTHER : BLOCK,DIST:- SOUTH 24 PARGANAS,WEST BENGAL-743383

CERTIFICATE NO : B/2016/0122221 DATE OF REGISTRATION : 05/11/2015

S-UHID : 86752751289988 REMARKS (IF ANY) :

DATE OF ISSUE : 20/01/2016 UDIN : ----

UPDATED ON : 2016-01-20 14:10:46 ISSUING AUTHORITY :

Signature Not Verified


Digitally Signed.
Name: TAPAS DAS
Date: 20-Jan-2024 14:28:44

REGISTRAR (BIRTH & DEATH)


RURAL HOSPITAL RAIDIGHI

"THIS IS A COMPUTER GENERATED CERTIFICATE."


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

"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH"

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