FXF5EJO
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) Supaul Municipal Corporation
of Tahsil/Block Supaul Sadar of District Supaul of State Bihar.
Name: SHIVAM KUMAR SOREN
Gender: male
Date of Birth: 09-JUNE-2021
Place of Birth: SUPAUL
Name of Father: SIKANDAR KUMAR SOUREN
Name of Mother: HASINA DEVI
Permanent Address : Village-Sundar Pur , PO-Bina ,Ward no-04 , DIST-Supaul , PIN-852131
Address of Parents at the time of Birth of Child : Village-Sundar Pur , PO-Bina ,Ward no-04 , DIST-Supaul , PIN-852131
Registration Number: 54438/8/7305/2026
Date of Registration: 22-MAY-2026
Date of Issue: 25-MAY-2026
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"