Civil Registration System https://crs-org.com/web/index.php/auth/birthCertificatePdf/B/bWF4...
स.ं 1 �प�-5
म�य �देश सरकार
No. 1 FORM-5
GOVERNMENT OF MADHYA PRADESH
योजना, आिथ�क एवं सांि�यक� िवभाग
DEPARTMENT OF PLANNING , ECONOMICS &
STATISTICS
िजला अ�पताल, िविदशा
DISTRICT HOSPITAL VIDISHA
ज�म �माण-प�
BIRTH CERTIFICATE
(ज�म मृ�यु रिज��ीकरण अिधिनयम, 1969 क� धारा 12 / 17 तथा म�य �देश ज�म मृ�यु रिज��ीकरण िनयम, 1999 के िनयम 8/13 के अतं ग�त जारी ि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�निलिखत सूचना ज�म के मूल अिभलेख से ली गई है जो िक िजला अ�पताल, िविदशा तहसील िविदशा िजला िविदशा 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
DISTRICT HOSPITAL VIDISHA OF TAHSIL/BLOCK VIDISHA OF DISTRICT VIDISHA OF STATE/UNION TERRITORY MADHYA PRADESH, INDIA.
नाम / NAME : ABHAY SINGH RAJPUT
िलंग / SEX : MALE
ज�म ितिथ | DATE OF BIRTH:
12-04-2017 ज�म �थान / PLACE OF BIRTH :
TWELVETH APRIL TWO THOUSEND SEVENTEEN VIDISHA
माता का नाम / NAME OF MOTHER:
CHAMAN िपता का नाम / NAME OF FATHER :
GRAN SINGH RAJPUT
आधार नंबर / MOTHER'S AADHAAR NO :
XXXXXXXX3763 आधार नंबर / FATHER'S AADHAAR NO:
XXXXXXXX8655
ब�चे के ज�म के समय माता-िपता का पता / ADDRESS OF PARENTS AT THE TIME OF BIRTH OF
THE CHILD : माता-िपता के �थायी पता / PERMANENT ADDRESS OF PARENTS:
GRAM KARELA POST KARELA VIDISHA VIDISHA (464226) GRAM KARELA POST KARELA VIDISHA VIDISHA (464226)
पंजीकरण सं�या / REGISTRATION NUMBER:
B-2022: 9-90347-002421 पजं ीकरण तारीख / DATE OF REGISTRATION:
15-04-2017
िट�पणी / REMARKS (IF ANY):
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जारी करने क� ितिथ / DATE OF ISSUE : जारी करने वाला �ािधकारी / ISSUING AUTHORITY :
13-10-22 12:55:47
UPDATED ON :
13-10-22 12:55:47
"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 सुिनि�चत कर�" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "
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