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GOVERNMENT OF GUJARAT
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DEPARTMENT OF HEALTH AND FAMILY WELFARE
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BIRTH CERTIFICATE
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(Issued under Section 12/17 of the Registration of Births and Deaths Act,1969
and Rule 8/13 of the Gujarat Registration of Birth and Deaths Rules, 2004)
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This is to certify that the following information has been taken from the original record of birth which
is in the register for Village/City BASPA of Taluka SAMI of District PATAN of Gujarat State, India

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1 Name : Prajapati Samarth 2 Sex(M/F) : Male
ale
Sureshkumar
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3 Date of Birth : 20/11/2015 4 Birth Place : Shamsherpura
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5 Name of Mother : Prajapati Kinjal 6 Name of Father : Prajapati Sureshkumar
Sureshkumar Chamanbhai
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7 Address of parents : At.Baspa,Ta.Sami,
,Ta.Sami, 8 Permanent address : At.Baspa
Baspa,Ta.Sami,
at the time of Birth Dist. Patan of Parents Dist. Patan
of Child
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9 Registration No. 8 10 Date of : 27/11
11/2015
Registration
11 Remarks (if Any)
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Date of Issue : 03/03/2024 5|DF65+ SF-LL VF5GFZ ;¿FlWSFZLGL ;CL
Signature of the issuing authority

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Address of the issuing authority
Ensure Registration of every Birth & Death
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