FRGT3H9
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: SHIVANI
Gender: female
Date of Birth: 01-JANUARY-2006
Place of Birth: MOGRABAV
Name of Father: RUMJA
Name of Mother: NANI
Permanent Address : GRAM MOGRABAV MOGRABAW PO SODPUR DIST DHAR MADHYA PRADESH 454010
Address of Parents at the time of Birth of Child : GRAM MOGRABAV MOGRABAW PO SODPUR DIST DHAR MADHYA PRADESH 454010
Registration Number: 68765/8/3567/2026
Date of Registration: 10-JANUARY-2006
Date of Issue: 25-JANUARY-2006
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"