Form-5
GOVERNMENT OF WEST BENGAL
DEPARTMENT OF HEALTH AND FAMILY WELFARE
KOLKATA MUNICIPAL CORPORATION
BIRTH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR KOLKATA MUNICIPAL CORPORATION OF BLOCK/MUNICIPALITY KOLKATA MUNICIPAL CORPORATION OF
DISTRICT KOLKATA OF STATE WEST BENGAL, INDIA.
NAME : RAJARSHI MALLIK GENDER : MALE
DATE OF BIRTH : 12/04/1983 PLACE OF BIRTH : WOODLANDS NURSING HOME,CAL-27 ,
WARD HEALTH UNIT 24
NAME OF MOTHER : ANITA MALLIK NAME OF FATHER : DR. DEBABRATA MALLIK
MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : -
XXXXXXXX1440
PRESENT ADDRESS OF MOTHER 9/3/1,BEDIA PARA LANE,DUMDUM,CAL-77
AT THE TIME BIRTH OF THE
CHILD :
PERMANENT ADDRESS OF 9/3/1,BEDIA PARA LANE,DUMDUM,CAL-77
MOTHER :
CERTIFICATE NO : I/04/1983/11396 DATE OF REGISTRATION : 26/10/1983
S-UHID : REMARKS (IF ANY) :
DATE OF ISSUE : 15/09/2022 ISSUING AUTHORITY :
UPDATED ON : 2022-09-15 14:18:43
Signature Not Verified
Digitally Signed.
Name: PURABI PANDEY
Date: 15-Sep-2022 14:48:20
SUB-REGISTRAR (BIRTH & DEATH)
KOLKATA MUNICIPAL CORPORATION
"THIS IS A COMPUTER GENERATED CERTIFICATE."
THE GOVT.OF 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 "
