FH72NMC
FORM NUMBER - 5
[SEE RULE - 8]

GOVERNMENT OF BIHAR

DEPARTMENT OF PLANNING AND DEVELOPMENT

DIRECTORATE OF ECONOMICS AND STATISTICS

BIRTH CERTIFICATE
(Issued under Section 12 of Registration of Births & Deaths Act, 1969 and Rule 8/13
of the Bihar Registration of Births and Deaths Rules 1999)
This is to certify that the following information has been taken from the original record
of Birth which is the register for (Local Body) Samastipur Municipal Corporation
of Tahsil/Block Samastipur Sadar of District Samastipur of State Bihar.
Name: PAILA PAIDAMMA
Gender: female
Date of Birth: 01-JANUARY-1974
Place of Birth: NAGAR NIGAM, SAMASTIPUR
Name of Father: PAILA BHASKARARAO
Name of Mother: PYLA LATCHAMMA
Permanent Address : 0-0, S C STREET,CHANDRASEKRARAJAPURAM,CHANDRASEKRARAJAPURAM,JIYYAMMAVALASA PARVATHIPURAM, ANDHRA PRADESH- 535526
Address of Parents at the time of Birth of Child : 0-0, S C STREET,CHANDRASEKRARAJAPURAM,CHANDRASEKRARAJAPURAM,JIYYAMMAVALASA PARVATHIPURAM, ANDHRA PRADESH- 535526
Registration Number: 31956/2/5255/2026
Date of Registration: 19-DECEMBER-2025
Date of Issue: 15-JANUARY-2026
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"