FO9IL6U
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) Patna Municipal Corporation
of Tahsil/Block Patna Sadar of District Patna of State Bihar.
Name: Shahenshah Hazique
Gender: male
Date of Birth: 25-SEPTEMBER-2013
Place of Birth: Kashmiri Kothi Sadar Gali Patna City Patna Bihar - 800008
Name of Father: Shahenshah Zafar
Name of Mother: Soni Parveen
Permanent Address : Kashmiri Kothi Sadar Gali Patna City Patna Bihar - 800008
Address of Parents at the time of Birth of Child : Kashmiri Kothi Sadar Gali Patna City Patna Bihar - 800008
Registration Number: 63494/2/5807/2026
Date of Registration: 30-SEPTEMBER-2013
Date of Issue: 30-SEPTEMBER-2013
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"