Tarak Pob

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Form-5

GOVERNMENT OF WEST BENGAL


DEPARTMENT OF HEALTH AND FAMILY WELFARE

HOWRAH 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 HOWRAH DISTRICT HOSPITAL OF TAHSIL/BLOCK HOWRAH OF DISTRICT HOWRAH OF
STATE/UNION TERRITORY WEST BENGAL , INDIA.

NAME : TARAK SARKAR GENDER : MALE

DATE OF BIRTH : 02-01-1977 PLACE OF BIRTH : HOWRAH DISTRICT HOSPITAL

NAME OF MOTHER : RINA SARKAR NAME OF FATHER : GOPAL SARKAR

MOTHERS IDENTITY PROOF : XXXXXXXXXXNA FATHERS IDENTITY PROOF : XXXXXXXXNA

PRESENT ADDRESS OF MOTHER


AT THE TIME BIRTH OF THE 21/1 MUKHERJEE PARA ROAD BHATPARA NORTH 24 PGS WEST EBNGAL 743123
CHILD :
PERMANENT ADDRESS OF
21/1 MUKHERJEE PARA ROAD BHATPARA NORTH 24 PGS WEST EBNGAL 743123
MOTHER :

CERTIFICATE NO : B/202473196 DATE OF REGISTRATION : 15-10-2013

S-UHID : 98870991721340 REMARKS (IF ANY) :

DATE OF ISSUE : 15-10-2013 ISSUING AUTHORITY :

UPDATED ON : 03-06-2024 06:45:17

Signature Valid
Digitally Signed.
Name: SADIQUE KHAN
Date: 03-06-2024 06:45:17
REGISTRAR (BIRTH & DEATH)
HOWRAH DISTRICT HOSPITAL

"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"

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