wr lUlti‘iOS CIRCLE/LOCATION: Aged (Designation Firm) Residing at EET and Complete Address of the Individual of the . (Complete Door Number, Street and station has to be stated with Telephone Number). Declare that Lay ehiid/Female Child in green. = ein. fesued on 241 Sha2.. . Delivered Male Born/ pied VwaUePinctual Place of Event) on (Date of event}. The Birth/Death Certificates The Name/s was wrongly informed by o MA. |. (the person who informs the event las to be stated) Please do the following correction. | Tncorrect Name fines To be correct as cmd | 7 ANSHWIARYA TeoDu AISHWARYA mothe, | oT VENEATI | Tepeu VentRT) | | Fesnen | + venkat | Teepy ve wtaT eredo¥ EF Place: Visarropkr. SIGNATURE OF THE DECLARANT Date: o|npieuy (Declarant’s Name in Capital)1 sjoiwfo./D/o- Residing at - ‘The Signature HY presence and the contents: mentioned of the Decla by the Declarant Are true and correct ta the best of my knowledge and GAZETTED OF! Sign & Seal & (Name of the Officer) CSC Transaction Date : CSC Transaction No. The following documents should be produced by the Declarant for name Corrections in Birth/Death Registers: Declaration by the nearest relative (Parents /Children's/ Spouse} in case of Death and cither Father or Mother in case of liver Birth. The declaration stated should be true and correct by Two Gazetted Officers (Names Gazetted Officers are to be Written in CAPITALS). 3. Notary Affidavit on (Rs.10/- Non Judicial Stamped Paper} The Original Birth/Death Certificate already taken are to be returned. 5. Documentary Evidences like Educational Certificates, Election 1D Card, Ration Card, Passport, Driving Licenses, Marriage Certificate, LIC Policies, Caste Certificates, Property Papers etc. (Evidence to be submitted before Birth of the Child or Death of the Deceased). 6. Consent Letter from the concerned Hospital regarding the correction to the effect. 7. Other Child Certificate if any. 8. In case of Medico Legal Death a) Post Mortem Report c) Form-2 by concerned Police Station. 9. Any other support documents if any please specify. AySep ayo SB -rq-\F 0D, To Bos SOLED GBH dah GOCE, Tone) mqgedtso) eReaD Epa GA EBO « abaiavo'- ee QPSOO} axjo abot Nome contre nen} Derg Se. core 2, Badd fo Bay wore Sawey, Ts Levey Bae ie aes Boba pate ano) 5-4-2 BM aewb oped stacey A po gata ad eam® safalase des fyi Gayari Nucing Home , Hiseragihe oncos Tad ( Gy hy) ) ww’ cdeoSaoy we SHY qr Ho epots bMdoaeds dkbaduw USgo eos «SS pa hodTv esade Serum - AB SEcs coeds “AES - mich ftctere ortad T. nMARYA TEND ATSHRNIARY A, € wcueenl Teno YENEAT! Teppu VENC AT 2 T. VERICAAT foSyerosSed - rah thio BhewstO) « = 7eseF Caeadu wentat) Ph SER 22) 98GOVERNMENT OF ANDHRA PRAI DEPARTMENT OF MEDICAL, & HEL GREATER VISAKHAPAry, MUNICIPAL CORPORATION ANDHRA PRADESH INDIA FORM No. 5 0095494 Certificate of Birth Issued under section 12 /17 of the Registration of Birth and Death Act, 1969 This is to Certify that the following Information has been taken from the Original Record of Birth which is in the register for (Local Area) Beso TZ Sain of /8°= Ward of Greater Visakhapatnam Municipal Corporation, Visakhapatnam, of Diswrict Visakhapatnam of State Andhra Pradesh. Sex: CEMA e Dae of Binh: JF /2.-D0\0 Registration No. paso Place of Binh $4) GaeAe) At) 05,000 Brac’ot Registration :QY-)a-poip nl g aT losin Resin o SY Deaths: GREATER VISAKHAPATN AM MUNICIPAL CORPORATION ae Visit us at : wwrw.gvme.gow.in AMARRJD, "Kakinada Phone 0894-: VIDYA PARISHAD MLBT SCHOOL a (Recognised by Govt. of Andhra Pradash) #6-23-5/1, Enst Point Colony, Visakhapainam - 530 017, IM CONDUCT CERTIFIGATD Tres oceny nat SIELIDU... ALGHWARYA B| -——.. same. Maka. Vertkaki B roncams..th Ato, & eth Bet, SO Bosings of the Disp gh ci 0 Bon yep a sti Boards Viva " _ REN Sonia. tee rods. ty ue m R.C.No, 72 81/79 Dt 30-5-80 nam Ri isakhapat ORIGINAL TENDIX 16 Adma. No. + Ea5FOF 1 ARiale It Child 10 Form of Transfer Certificate a0 330 FRY ca (axighoal UBT ‘ Crryali vids faa OF: 'G Bo bbe porn “ eee ‘a Erhard maouse so GFSTTESLE VITA oy ab Nae of tie Mater ves 1) Name ot he Far © Sacto to Garton es ete moat and Religion J = Takase Gc-a © Sie nev he punt wat wong eine ¢ Teaving. (on word Whether qualified ft Whether she pupil hes ‘9 he acho 2, heer the pap was esi ty Sens i wa in receipt oP any the spect Whether ke ppt Concession (Nuun af First Language promi a risa we fs Soneecsiaa te Be a Ile. Bol Ig LSayenteerntp Sporeeten Iie: Oe Pues undergone medical © 5S Ee — during the year-fire ar repeat. ‘co be specitien 418 Pemomal marks of identification 16. Dien on which the pupil ncrully left the Schont ” wi Attendance in the Class of leaving days, Total aumber of working days 21. Signanere of the Head of the Schoey Nowe: O)Aneteon 1) mate om ‘Dixe on which spplicasion foe Transfer wean me sie Dy its Parent or Geant 15 Date af the Transier Cerificate ‘coNDUcT 2) Tranat ler Cent Wider the Andhra Pred, G) In case the puy coumter-signat ‘00, behalf of the pip obs under shall not pil is Heaving the State of Andis Pradesh, lure of the inspecting Officer concerned x ficute issued by sh Edu wren OEE Oy wad Rules" printed fo the Tes ssa ea by AMAYAN eee Dripaia pS CHOO rami econnised iEaLé Wall not Be ‘valid without the area lZs RAE PABz ta — MTuTe eda Sy Thgoin ous Sc Uniquaddentificetion Auth of india Ceewesoverriment of India ‘Reet ang / Enrotmen No 2017180682130 agers Tests lena Ta enka saad ed eer omens ‘Vesetapainen cura LB Gateny Vaainaanee urzer) Waakuraie Pracesh 530047 ‘astesase a5 Zam rem Bigs HEEEM0 SSR STEED SESCESSOESFT Sb word omy / Your Aaanasr No. 4515 5154 1524 eserd — ae orgy 2 ido DeLaKe = Government of na age om, Tee mors oh ag sane Mare" team vere sopeat Dob mtzane gi Femwe y 4515 5154 1524 ere PARAS aes), W180) WSLta erda aebace j overnment of | 22ra) oxy | Emotmant Mo 207 71605912113989 ostiom) wipathaserma— ‘SE508450531FT 3955 3655 6842 word — Sand sey, ca Be | , 3955 3655 6842 Foncd t L | Sb tecrb Roms / Your Aadhaar No. uaré — Sars Say = p aqpnosts 9343-72138B765 7976 2319 | Hah >. worS - PSP hp AMA FauaaSe a ea deer i Bob hehe fia | ; ts APB mre ee, “ eo a — agoeeés qa as| ‘ AFPIDAVIT |, TEDDU VENKATI (Andhaar No. 29: years, W/o. Teddu Venkat, resi Near Wallair Depot Visakd Prades 55 3655 6842) ng D.NO.5-4-24, Peels 33 ileripeta, ‘palnoam Distriet-530017, Andhra India, do hereby solemnly affirm and state os follows: itis submitted that 1 was blessed with Female Child by name TEDDU AISHWARYA who was born on 17-12-2010 Gayatri Nursing Home, Visakhapatnam, bearing Registration No. 26, Dated: 24-12-2010. In online records my name and my Husband's name and al my child names were wrongly mentioned and also inc f child’s name in birth Certificate, due to lack of my knowledge, instead of mentioning my correct name is TEDDU VENKATI i: was mentioned wrongly as ‘T. VENKATI, instead of mentior Husband's correct name is TEDDU VENKAT it was mention wrongly as T. VENKAT and also instead of mentioning my chi sorrect name is TEDDU AISHWARYA, it was mentioned wrongly as A, AISHWARYA. Hence, I request the Greater Corporation authorities, Visakhapat: Affidavit and correct my name, child's name in your records a: te my child to me. Visakhapatnam Municipal nam may please accept my my busband’s name and also my md issue Fresh Birth Certificate of Wrong Name of the Father; ‘T, VENKAT. Correct Name of the Father; TEDDU VENKAT. Wrong Name of the Mother: —T. VENKATI Correct Name of the Mother: TEDDU VENKATI Wrong Name of the Child T. AISHWARYA ‘Correct Name of the Child TEDDU AISHWARYA The facts stated above are trué and correct. Solemnly affirme November, 2024 at Vi: DEPONENT d and signed before me on this 27% day of isakhapatnam. ) ow i Apart TNAM - $3001