FORM-5
NO. 1 GOVERNMENT OF MANIPUR
DEPARTMENT OF MEDICAL HEALTH AND FAMILY WELFARE
SERVICES
DISTRCT HOSPITAL,CHURACHANDPUR
BIRTH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MANIPUR
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 DISTRCT HOSPITAL,CHURACHANDPUR OF TAHSIL/BLOCK CHURACHANDPUR OF DISTRICT CHURACHANDPUR OF
STATE/UNION TERRITORY MANIPUR, INDIA.
NAME: TETE KHUOLNEIHZEM SEX: FEMALE
DATE OF BIRTH:
PLACE OF BIRTH:
01-12-2009
DISTRICT HOSPITAL CHURACHANDPUR
FIRST-DECEMBER-TWO THOUSAND NINE
NAME OF MOTHER: NAME OF FATHER:
NIENGTHIENHOIH H THANGLALMUON
MOTHER'S AADHAAR NO: FATHER'S AADHAAR NO:
XXXXXXXX1340
XXXXXXXX1300
ADDRESS OF PARENTS AT THE TIME OF BIRTH OF THE CHILD: PERMANENT ADDRESS OF PARENTS:
PAUGIN ROAD,
CHIENGKONPANG, CHENGKONPANG, , CHURACHANDPUR, PAUGIN ROAD,
CHURACHANDPUR, MANIPUR- 795128 CHIENGKONPANG, CHENGKONPANG, CHURACHANDPUR,
CHURACHANDPUR,
MANIPUR- 795128
REGISTRATION NUMBER: DATE OF REGISTRATION:
B-2024: 14-01758-002649 08-05-2024
REMARKS (IF ANY):
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DATE OF ISSUE: ISSUING AUTHORITY :
08-05-2024
REGISTRAR (BIRTH & DEATH)
DISTRCT HOSPITAL,CHURACHANDPUR
UPDATED ON :
08-05-2024 12:43:34
"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 "
