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Iz i la- 5 FORM NO. 5 tUe izek. k i k BIRTH CERTIFICATE tUe vkSj e R q jftLV hdj. k vf/kfu e 1969 dh /kkjk 12 17 vkSj jktLFkku tUe vkSj e R q jftLV hdj. k fu e 2000 ds fu e 8 13 ds v/khu tkjh fd k x k Issued under Section 12/17 of the Registration of Births and Deaths Act 1969 and Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules 2000 g izekf*kr fd k tkrk gS fd fuEu fyf kr lwpuk tUe ds ewy vfHkys k ls yh xbZ gS tks fd LFkkuh ks k LFkkuh fudk -------------------------------------------------------- rglhy k. M ------------------------------------------------------------------------------ ftyk ------------------------------------------------------------------------------------------jkT - la k jkT ks k-------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of birth which is the register for local area / local body. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. tUe frfFk Date of Birth. tUe LFkku Place of Birth. ekrk dk uke Name of Mother. cPps ds tUe ds le ekrk firk dk irk ekrk firk dk LFkk h irk Address of parents at the time of birth of the child Permanent address of parents. jftLVdj. k la- Registration No. jftLV hdj. k dh rkjh k Date of Registration fVIi. kh Remarks if any. tkjh djus dh rkjh k Date of issue. tkjhdjus okys izkf/kdkjh ds gLrk kj Signature of the issuing authority tkjhdjus okys izkf/kdkjh dk irk Address of the issuing authority eqgj Seal. k fu e 2000 ds fu e 8 13 ds v/khu tkjh fd k x k Issued under Section 12/17 of the Registration of Births and Deaths Act 1969 and Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules 2000 g izekf*kr fd k tkrk gS fd fuEu fyf kr lwpuk tUe ds ewy vfHkys k ls yh xbZ gS tks fd LFkkuh ks k LFkkuh fudk -------------------------------------------------------- rglhy k. M ------------------------------------------------------------------------------ ftyk ------------------------------------------------------------------------------------------jkT - la k jkT ks k-------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of birth which is the register for local area / local body. M ------------------------------------------------------------------------------ ftyk ------------------------------------------------------------------------------------------jkT - la k jkT ks k-------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of birth which is the register for local area / local body. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. tUe frfFk Date of Birth. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. tUe frfFk Date of Birth. tUe LFkku Place of Birth. ekrk dk uke Name of Mother. cPps ds tUe ds le ekrk firk dk irk ekrk firk dk LFkk h irk Address of parents at the time of birth of the child Permanent address of parents. .

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