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NIO. 1 GOVERNMENT OF UTTAR PRADESH FORM.5
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BIRTH CERTIFICATE

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THIS IS TO CERTIFY THAT THE FOLLOWINC INFORMATION HAS BEEN
TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
NIGAM MORADABAD OF TAHSIL/BLOCK MORADABAD OF DISTRIC? MORADABAD THE REGISTER FOR NAGAR
OF STATE/UNION TER.RITORY UTTAR PRADESH, II{DA.

NAME: GUNJAN
DATE OF BIRTH: SEX: FEMALE
PI,ACE OF BIRTT{:
15-09-2004
DISTT HOSHPITAL MORADABAD

NAMEOFMOTHER:
6AJNESH
NAME OF FATHAR
MANO} I(UMAR

MOTHER'S AADHAAR NO;

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ADDRESS OF PARENTS AT T}IE TIME OF CHILD
MORAD.ABAD MOITADABAD ADDRESS OF PARENTS AT THE TIME OF CHILD
MOLADABAD UTTAR PRADESI], 244881 MORADABAD MORADABAD
MORADABAD UTTAR FBADESH, 244OO1

REGISTRATION NUMBEttT
DATEOFREGISTRATI0N: ?8-03-29?3
B -2023: 9 -03610 -L427 5? !
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DATE GF ISSUE:
ISSUINGAUTHORITY:
e8-03-2023
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UPDATED ON:
28-03-2823 1C:20:10

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" THE GOVT- OF INDIA VIDE CIRCULAR NO.1/!2/20L4-VS(CRS)
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MORADITBAD OF STATE/UNION TERRITORY UTTAR PRADESH,
INDIA
NAME: GUNJAN
DATE OF BIRTH: SEft FEM"{LE
PLACE OF BIRTH:
15-09-2004
DISTT HOSHPITAL MORADABAD

NAMEOFMOTHER:
6A.lNESH
NAME OF FATTTAR
MANOJ (UMAR

MOTHER'S AADHAAR NO;

xxxxxxxx6847 3{IER ;id-{ / FATHER'S AADHAAR NO:
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ADDRESS OF PAR.ENTS AT THE TIME OF CHILD
MORADABAD MOtsAD.&BAD ADDRESS OF PARENTS AT THE TIME OF CHILD
MORADABAD UTT,A.IT PRADESH, 244AA1 MORADABAD MORABABAD
MORADABAD UTTAR P*ADE5}{, r44OO1

REGISTRATION NUMBEK
DATE OFRECISTRATION: 28-03-2023
B -20 23: 9 - 0 3 6 1,0 - 1 42 7 52 l
M[ /RFMARKS{rFANy):

DATE OF ISSUE:
ISSUINGAUTHORITY :
?a-03-2023
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R"EGISTRAR (BTRTH & DEATH)
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NAGAR NTCAM MORADAB,qD

UPDATED ON:
24"83-ZB?3 1O:2G:10

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FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
"zi-luly-2015
" THE covr. 0F rNDrA vrDE CTRCULAR No. 1/12/2,0L4-vS(CnSt
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