The land of the Dancing Deer

 

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FORM NO. 5
(See Rule 8)

BIRTH CERTIFICATE
(Issued under Section 12/17)

 

 

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

____________________________________________________________________________

No disclosure shall be made of particulars regarding the cause of death as entered in the Register. See provision  to Section 17(1)


D/P&S -- No. 811/28-4-2000 – Medical – 20,000 –C/15-5-2000.