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Shree Shash Wat

This document is a birth certificate issued by the Community Health Centre in Kheragarh, Agra, Uttar Pradesh, India. It certifies the birth of Shreeshashwat Updhyay on April 29, 2009 in Kagarol, Kheragarh. The certificate provides details of the child's name, sex, date and place of birth. It also lists the names and identification numbers of the mother (Roma Updhyay) and father (Pankaj Kumar), as well as their addresses at the time. The registration number and date are provided. The certificate was issued on November 1, 2022 and contains the facsimile signature of the issuing authority.

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72 views1 page

Shree Shash Wat

This document is a birth certificate issued by the Community Health Centre in Kheragarh, Agra, Uttar Pradesh, India. It certifies the birth of Shreeshashwat Updhyay on April 29, 2009 in Kagarol, Kheragarh. The certificate provides details of the child's name, sex, date and place of birth. It also lists the names and identification numbers of the mother (Roma Updhyay) and father (Pankaj Kumar), as well as their addresses at the time. The registration number and date are provided. The certificate was issued on November 1, 2022 and contains the facsimile signature of the issuing authority.

Uploaded by

tc1smarty2
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
सामुदायक वाय क खेरागढ़
COMMUNITY HEALTH CENTRE KHERAGARH

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 सामुदायक वाय क खेरागढ़ तहसील खेरागढ़ िजला आगरा
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 COMMUNITY HEALTH CENTRE KHERAGARH OF TAHSIL/BLOCK KHERAGARH OF DISTRICT AGRA OF STATE/UNION TERRITORY UTTAR PRADESH,
INDIA.

नाम / NAME: SHREESHASHWAT UPADHYAY लंग / SEX: पुरष / MALE

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


29-04-2009 KAGAROL,
TWENTY-NINTH-APRIL-TWO THOUSAND NINE KHERAGARH,KHERAGARH, AGRA,
UTTAR PRADESH

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


ROMA UPADHYAY PANKAJ KUMAR

आधार नंबर / MOTHER'S AADHAAR NO: आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX0194
XXXXXXXX7025

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:

KAGAROL, , KHERAGARH, AGRA, UTTAR PRADESH- 283119 KAGAROL, KHERAGARH, AGRA,


UTTAR PRADESH- 283119

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


B-2009:009/97 29-04-2009

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY :
01-11-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
सामुदायक वाय क खेरागढ़
COMMUNITY HEALTH CENTRE KHERAGARH

UPDATED ON :
01-11-2022 15:30:49

"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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