c Civil Registration System

Birth Reporting X

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To

Death Reporting X

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सं. 1
No. 1
 
  प्रपत्र-5
Form-5
  
 
 
  GOVERNMENT OF ASSAM  
 
DEPARTMENT OF HEALTH AND FAMILY WELFARE
 
 
   
       
    BIRTH CERTIFICATE
BIRTH CERTIFICATE 		   
         
         
 
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ASSAM REGISTRATION OF BIRTHS & DEATHS RULES 1999.) 		 
         
         
 
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR MUNICIPAL BOARD GOLAGHAT OF TAHSIL/BLOCK GOLAGHAT OF DISTRICT GOLAGHAT OF STATE/UNION TERRITORY ASSAM, INDIA. 		 
         
         
 
NAME / Name: RUMI KHATUN SEX / Sex: FEMALE
DATE OF BIRTH/ Date of Birth:
02-02-1998
TWO FEBRAURY ONE THOUSAND NINE HUNDRED NINTY EIGHT 		PLACE OF BIRTH/ Place of birth:
KATLAMARI GOPALPARA ASSAM 783330
NAME OF MOTHER / Name of Mother:
SOBIYA KHATUN 		NAME OF FATHER / Name of father:
ROBIYAL ALI
AADHAAR NO / MOTHER'S AADHAR:
  		AADHAAR NO / FATHER'S AADHAR
 
ADDRESS OF PARENTS AT THE TIME OF BIRTH OF THE CHILD / Address of parents at the time of birth of the child:
KATLAMARI GOPALPARA ASSAM 783330
PERMANENT ADDRESS OF PARENTS / Permanent address of parents:
KATLAMARI GOPALPARA ASSAM 783330
REGISTRATION NUMBER / Registration Number:
B-2024: 09-90347-008979 		DATE OF REGISTRATION / Date of Registration:
05-08-2018
REMARKS / Remarks (if any):
---

DATE OF ISSUE / Date of issue:
10-06-24 12:08:14 		ISSUING AUTHORITY / Issuing Authority :

REGISTRAR (BIRTH & DEATH)
नगरपालिका बोर्ड गोलाघात
MUNICIPAL BOARD GOLAGHAT
Updated on :
10-06-24 12:08:14
 
   
 
"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".
" ENSURE REGISTRATION OF EVERY BIRTH AND DEATH" / "Ensure registration of every birth and death" 		 
         
       
         
 
 
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