FVH6MKO
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) East Champaran Municipal Corporation
of Tahsil/Block East Champaran Sadar of District East Champaran of State Bihar.
Name: Prince Kumar
Gender: male
Date of Birth: 26-FEBRUARY-2017
Place of Birth: Home
Name of Father: Raj Kumar
Name of Mother: Durga Devi
Permanent Address : Gulwara Madhuban, madhuban, East Champaran, Bihar-845420
Address of Parents at the time of Birth of Child : Gulwara Madhuban, madhuban, East Champaran, Bihar-845420
Registration Number: 36077/4/3537/2026
Date of Registration: 24-FEBRUARY-2018
Date of Issue: 02-MARCH-2018
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"