मांक 1 महारा शासन फॉम-5
NO. 1 GOVERNMENT OF MAHARASHTRA FORM-5
आरोय वभाग
DEPARTMENT OF HEALTH
NAGAR PALIKA JAT
जम माणप
BIRTH CERTIFICATE
जम व मृयु नदणी अधनयम, 1969 या कलम 12/17 आिण महारा जम आिण मृयु नदणी नयम, 2000 चे नयम 8/13 अवये देयात आले आहे.
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MAHARASHTRA REGISTRATION OF
BIRTHS & DEATHS RULES 2000)
मािणत करयात येत आहे क, खालल माहती जमाया मूळ अभलेखाया नदवहतून घेयात आल आहे , जी क नगर पालका जत , तालुका जत , िजहा
सांगल , महारा राया, भारत या नदवहत उलेख आहे.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR
NAGAR PALIKA JAT OF TAHSIL/BLOCK JAT OF DISTRICT SANGLI OF STATE/UNION TERRITORY MAHARASHTRA, INDIA.
नाव / NAME: SHAIKH MINHAZ SHAIKH MAHEMOOD लंग / SEX: पुरष / MALE
आधार मांक / AADHAAR NO.:
XXXXXXXX4013
जम तारख / DATE OF BIRTH:
जम ठकाण/ PLACE OF BIRTH:
20-10-1998
DEGLOOR
TWENTIETH-OCTOBER-ONE THOUSAND NINE HUNDRED NINETY EIGHT
आईचे पूण नाव / NAME OF MOTHER: वडलांचे पूण नाव / NAME OF FATHER:
AJMERI BEGUM SHAIKH MAHEMOOD SHAIKH MAHEMOOD
आधार मांक / MOTHER'S AADHAAR NO: आधार मांक / FATHER'S AADHAAR NO:
XXXXXXXX9499
बाळाया जमायावेळी आई-वडलांचा पा / ADDRESS OF PARENTS AT THE TIME OF BIRTH आई-वडलांचा कायमचा पा/ PERMANENT ADDRESS OF
OF THE CHILD: PARENTS:
LINE GALLI,
DEGLOOR POST- , DEGLUR, , DEGLUR, NANDED, MAHARASHTRA- 431717 LINE GALLI,
DEGLOOR POST-, DEGLUR, DEGLUR, NANDED,
MAHARASHTRA- 431717
नदणी मांक / REGISTRATION NUMBER: नदणी दनांक / DATE OF REGISTRATION:
B-2021: 27-90367-000468 30-04-2021
शेरा / REMARKS (IF ANY):
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माणप दयाचा दनांक / DATE OF ISSUE: नगमत करणारे ाधकार / ISSUING AUTHORITY :
30-04-2021
रिजार (जम व मृयु)
REGISTRAR (BIRTH & DEATH)
NAGAR PALIKA JAT
UPDATED ON :
30-04-2021 13:22:30
"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 जम आिण मृयूची घटना नदयाची खाी करा " / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "
