FC0427V
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) Rohtas Municipal Corporation
of Tahsil/Block Rohtas Sadar of District Rohtas of State Bihar.
Name: Sanju Devi
Gender: female
Date of Birth: 01-FEBRUARY-1986
Place of Birth: Maliyabag, semari, dawath, rohtas, bihar 802211
Name of Father: Hardeo Pal
Name of Mother: Kamla Devi
Permanent Address : Maliyabag, semari dawath, rohtas, Bihar 802211
Address of Parents at the time of Birth of Child : Maliyabag, semari, dawath,rohtas,bihar 802211
Registration Number: 25196/6/5931/2026
Date of Registration: 05-JUNE-2010
Date of Issue: 08-JUNE-2010
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"