Form-5
GOVERNMENT OF WEST BENGAL
DEPARTMENT OF HEALTH AND FAMILY WELFARE
BARASAT DISTRICT HOSPITAL
BIRTH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST
BENGAL
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH
WHICH IS THE REGISTER FOR BARASAT DISTRICT HOSPITAL OF TAHSIL/BLOCK BARASAT OF DISTRICT NORTH 24
PARGANAS OF STATE/UNION TERRITORY WEST BENGAL, INDIA.
NAME : KRISHNA DAS GENDER : MALE
BARASAT DISTRICT
DATE OF BIRTH : 27-11-1962 PLACE OF BIRTH :
HOSPITAL
NAME OF MOTHER : KUSUM DAS NAME OF FATHER : BASANTA DAS
MOTHERS IDENTITY PROOF : XXXXXXXXNA FATHERS IDENTITY PROOF : XXXXXXXXNA
PRESENT ADDRESS OF
MOTHER ANANDA BAZAR 25 TH OLD ELECTRIC OFFICE NAIHATI NAIHATI NORTH 24 PGS WEST
AT THE TIME BIRTH OF THE BENGAL 743165
CHILD :
PERMANENT ADDRESS OF ANANDA BAZAR 25 TH OLD ELECTRIC OFFICE NAIHATI NAIHATI NORTH 24 PGS WEST
MOTHER : BENGAL 743165
CERTIFICATE NO : B/2024581018 DATE OF REGISTRATION : 10-06-2008
S-UHID : 98870991312487 REMARKS (IF ANY) :
DATE OF ISSUE : 10-06-2008 ISSUING AUTHORITY :
UPDATED ON : 16-07-2024 [Link]
Signature Valid
Digitally Signed.
Name: SADIQUE KHAN
Date: 16-07-2024 [Link]
REGISTRAR (BIRTH & DEATH)
BARASAT DISTRICT HOSPITAL
"THIS IS A COMPUTER GENERATED CERTIFICATE."
THE [Link] INDIA VIDE CIRCULAR NO. 1 / 12 / 2014 - VS(CRS) DATED 27 - JULY - 2015
HAS APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES
"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH"
