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सं.

1 मय देश सरकार प-5


NO. 1 GOVERNMENT OF MADHYA PRADESH FORM-5
योजना, आिथक एवं सांियक वभाग
DEPARTMENT OF PLANNING, ECONOMICS & STATISTICS
नगर नगम वालयर
MUNICIPAL CORPORATION GWALIOR

जम माण-प
BIRTH CERTIFICATE

(जम मृयु रिजकरण अधनयम, 1969 क धारा 12 / 17 तथा मय देश 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 MADHYA PRADESH
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 नगर नगम वालयर तहसील गद िजला वालयर
राय/संघ देश मय 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 MUNICIPAL CORPORATION GWALIOR OF TAHSIL/BLOCK GIRD OF DISTRICT GWALIOR OF STATE/UNION TERRITORY MADHYA
PRADESH, INDIA.

नाम / NAME: YASHVARDHAN TIWARI लंग / SEX: पुरष / MALE

जम तथ / DATE OF BIRTH:


जम थान/ PLACE OF BIRTH:
01-11-2008
THAKUR NURSING HOME GWALIOR
FIRST-NOVEMBER-TWO THOUSAND EIGHT

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


POOJA TIWARI PRADEEP KUMAR TIWARI

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

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:
LAKKAD KHANA ROAD NEAR MADHOGANJ POLICE STATION, MADHOGANJ LAKKAD KHANA ROAD NEAR MADHOGANJ POLICE STATION,
LASHKAR, MADHOGANJ LASHKAR,
GWALIOR, , GIRD, GWALIOR, MADHYA PRADESH GWALIOR, GIRD, GWALIOR,
MADHYA PRADESH

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


B-2023: 23-90024-014348 02-08-2023

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
02-08-2023
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नगर नगम वालयर
MUNICIPAL CORPORATION GWALIOR

UPDATED ON :
02-08-2023 14:11:47

"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".

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

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