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FORM NOS
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Government of Rajasthan
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Directorate of Economics & Sfati5 fics
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Registrar - Phagotara, BHINMAAL, JALORE
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BIRTH CERTIFICATE
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-.:fr{ nra TIJ<.T <1Jlft4iei lf'r ~~I ter for (Local area I Local
recoro of btrth which
been taken from the ong1nal is the regrs
\AL 01 Drstnct JALORE of State / Union Territory RaJasthan.
PHAGOTAAA •:'t
film/Sex· ~/FEMALE
;nJ..•/N,n,e · ~ ~I TA DE\VASI
~ ~/Place of Birth:
31n ~ - o i ct Birth• 4/1 2/2018 FAGOTRA
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, ci Mother ~ ~ / BADAL! DEVI FAGOTRA

}l@T oJ :f ~/Mother Aadhar No:

~ rf,.. .rfiR°/Name of Father: ~ ~, BHAGAVANA RAM

~ q-il 3fltlR' ;nrr/Father Aadhar No:

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Address of parents at the time of birth of the child : Permanent Address of the parents :
q;pm:m- / ~ / 1fr.r1m;r / ~ / Wif"l..f I QSl•~cHI / QSl•~cHI I lfti1'1fol / ~ / tral"ftnill
PHAGOTR/ / PHAGOTARA I BHINMAAL I PHAGOTRA I PHAGOTAFiA I BHINMAAL /
JALORE I RA.., ~STHAN JALORE / RAJASTHAN

(~~ifi.!Di mr/Registration No: ~fv1~q;~u, ~ c=rrfug/Date of Registration :

0B 116005880020000122 I 2020 19L1.0/2020 .
~,gnature valid~
~/Remarks If Any : Digitally signed by B ati
171116.10.20 I 179116.10.20 Date: 2020.10.2110: 1ST
Reason: Document Ap ove

3Jt ~ .~ aRRl Date of Issue ; 21/10/2020

;;mt ~ ~ ~ t- ~ I Signature of issuing authority
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Note. Information in respect of the columns "Present address of parents at the time of birth of the child" and "Permanent address of parents" were
not applicable befort1 01/0112007
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UH of D19/tal Signature for issuing birth and death certificate is recogn.zed by Economics and Statistics Department, Governent of Rajasthan v1de
. 'Cular number F13/1139NSIDES/2013/22519 Dated 02.06 201 i::.
are Cou,,_y National Informatics Centre (NIC). Raias