iz:i la- 5 FORM NO. 5 tUe izek.k & i=k BIRTH CERTIFICATE ¼ tUe vkSj e`R;q jftLVªhdj.k vf/kfu;e] 1969 dh /kkjk 12@17 vkSj jktLFkku tUe vkSj e`R;q jftLVªhdj.k fu;e] 2000 ds fu;e 8@13 ds v/khu tkjh fd;k x;k ½ ( Issued under Section 12/17 of the Registration of Births and Deaths Act,1969 and Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules, 2000 ) ;g izekf.kr fd;k tkrk gS fd fuEu fyf[kr lwpuk tUe ds ewy vfHkys[k ls yh xbZ gS tks fd ¼LFkkuh; {ks=k@LFkkuh; fudk; ½ --------------------------------------------------------- rglhy @[k.M ------------------------------------------------------------------------------ ftyk ------------------------------------------------------------------------------------------jkT;-@la?k jkT; {ks=k-------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of birth which is the register for (local area / local body)...........of tahsil / block ........... of District............of state / Union territory ........... uke@Name: ............................. fyax@ Sex............................................ tUe frfFk@Date of Birth ............................ tUe LFkku @Place of Birth ............................ ekrk dk uke@Name of Mother...................................................................... firk dk uke @ Name of Father.......................................................................... cPps ds tUe ds le; ekrk firk dk irk ekrk&firk dk LFkk;h irk Address of parents at the time of birth of the child: Permanent address of parents: ............................. .............................................. ............................. .............................................. ............................. .............................................. jftLVdj.k la-@Registration No:. ................. jftLVªhdj.k dh rkjh[k@ Date of Registration .............................. fVIi.kh@Remarks(if any)................................................................................................................ tkjh djus dh rkjh[k @ Date of issue:.......................tkjhdjus okys izkf/kdkjh ds gLrk{kj@ Signature of the issuing authority tkjhdjus okys izkf/kdkjh dk irk @ Address of the issuing authority eqgj@Seal
