BIRTH CERTIFICATE जन्म प्रमाण पत्रSEX / :MALE AADHAAR NUMBER / :XXXX-XXXX-7715 DATE OF BIRTH / :09-08-1993PLACE OF BIRTH / :NAME OF MOTHER / :NAME OF FATHER / :AADHAAR NUMBER OF MOTHER / :AADHAAR NUMBER OF FATHER / :ADDRESS OF PARENTS AT THE TIME OF BIRTH OF THE CHILD / :PERMANENT ADDRESS OF PARENTS / :REGISTRATION NUMBER / :B20250929811807539 DATE OF REGISTRATION / :22-04-2026 REMARKS (IF ANY) / : DATE OF ISSUE / :25-04-2026S.No. 1 No. 1 FORM 5 Form-5 Updated On : 25-04-2026 09:36:48 ‘This QR code can be used to check the authenticity of the certificate’ SIGNATURE OF ISSUING AUTHORITY / : "ENSURE REGISTRATION OF EVERY BIRTH AND DEATH / "
AKBOR ALI
NINTH-SEPTEMBER-NINETEEN NINETY THREE
SAHARA KHATUN
ABDUL MOZID
NAME / :
GOVERNMENT OF ASSAM
DEPARTMENT OF PLANNING AND DEVELOPMENT
HARISINGA MODEL HOSPITAL
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ASSAM REGISTRATION OF BIRTHS & DEATHS RULES 1999.)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS THE REGISTER FOR HARISINGA MODEL HOSPITAL OF TAHSIL/BLOCK UDALGURI OF DISTRICT UDALGURI OF STATE/UNION TERRITORY ASSAM, INDIA.
