b.ddo.
C.A.No. 0 5
(o 10 s)
E.S. FORM NO. 5
1764 (See Rule 10)
GOVERNMENT OFANDHRA PRADESH
DEPARTMENT OF MEDICAL &HEALTH SERVICES (VITAL STATISTICS)
O
CERTIFICATE OF BIRTH
19695 ossSss 33 so8co S r ) d S 17 8o s s ë .
Issued under Section 17 of the Registration of Births and Deaths Act. 1969
CIRCLE: 10
This is to certity that the following information has been taken from the original record of births which is in the register
for of Municipal Corporation, RAJAHMUNDRY of District East Godavari of state ANDHRA PRADESH.
1702
REGISTRATION NO.
2 05-12-2007
DATE OF REGISTRATION
3. 29-11-2007
DATE OF BIRTH
. p.
SEX
NAME
6
PLACE OF BIRTH ULTUR
r s b iwEDaDA,O. .
NAME OF THE FATHER
8.
NAME THE MOTHER
250130Hi8
DATE
a365 bca desapav 224
SEAL REGISTRAR OF BIRTHS & DEATHS
MUNICIPAL CORPORATION, RAJAHMUNDRY
SEoDED/sdÖEsoOSOHEO
PREPAREO B STATISTICIAN /DY S.O