FORM NO. 5 |
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| This is to certify that the following information has been taken from the original record of birth which is the register for
(LocalArea)
of
. Tahsil
of District
.. of State
............. Name: .. Sex : .. Date of Birth : ..... Place of Birth : ... Name of Father :. ... Name of Mother: ... Registration No.: ... Date of Registration : .. Date : .. Signature of Issuing Authority Seal ____________________________________________________________________________ |
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