Scribd
Upload
66 views1 page

SAMRAT

Uploaded by

khatriumesh843
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
66 views1 page

SAMRAT

Uploaded by

khatriumesh843
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

OMD" - 5 FORM-5

U]HZFT ;ZSFZ
GOVERNMENT OF GUJARAT
VFZMuI VG[ 5ZLJFZ S<IF6 lJEFU
DEPARTMENT OF HEALTH AND FAMILY WELFARE
HgD 5|DF65+
BIRTH CERTIFICATE
sHgD VG[ DZ6 GM
GM\W6L VlGlGID4 !)&) GL S,Dv!Zq!* VG[
U]HZFT HgDvDZ6 GMGM\W6L lGIDM4 Z__$ GF lGIDv( D]HAf
(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)
VFYL 5|DFl6T SZJFDF\ VFJ[ K[ S[4 GLR[GL DFlCTL HgDGF D}/ Z[S0"DF\FYL ,[JFDF\ VFJL K[P H[ U]H
HZFT
ZFT ZFHIGF 5F86
lH<,FGF ;DL TF,]SFGF AF:5F UFDGF ZlH:8ZDF\ K[P
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

! GFD o 5|HF5lT ;DY" ;]Z[XS]DFZ Z HFlT s5]Pq:+Lf o 5]~QF


1 Name : Prajapati Samarth 2 Sex(M/F) : Male
ale
Sureshkumar
# HgD TFZLB o Z_q!!qZ_!5 $ HgD :Y/ o ;DX[Z5]ZF
3 Date of Birth : 20/11/2015 4 Birth Place : Shamsherpura
5 DFTFG]\ GFD o 5|HF5lT lS\HH,, ;]Z[XS]DFZ & l5TFG]\ GFD o 5|HF5lT ;]Z[XS]DFZ RDGEF.
5 Name of Mother : Prajapati Kinjal 6 Name of Father : Prajapati Sureshkumar
Sureshkumar Chamanbhai
* AF/SGF HgD ;DI[ o D]\PAF:5F4 TFP;DL4 lHP5F86 ( DFTFvl5TFG] SFIDL o D]\PAF:5F4
AF:5F TFP;DL4 lHP5F86
DFTFvl5TFG]\ ;ZGFD] ;ZGFD]\
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
) ZlH:8[=XG G\P o ( !_ ZlH:8[=XG TFZLB o Z*q!!qZ_!5
!!qZ_!5
9 Registration No. 8 10 Date of : 27/11
11/2015
Registration
11 Remarks (if Any)
5|DF65+ SF-L VF%IFGL TFZLB o _#q_#qZ_Z$
qZ_Z$
Date of Issue : 03/03/2024 5|DF65+ SF-LL VF5GFZ ;¿FlWSFZLGL ;CL
Signature of the issuing authority

5|DF65+ SF-LL VF5GFZ ;¿FlWSFZLG]\ ;ZGFD]\


Address of the issuing authority
Ensure Registration of every Birth & Death
NZ[S HgD VG[ DZ6GL GM\
GMW6L VJxI SZFJLV[P

You might also like