FHKOC43
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) Buxar Municipal Corporation
of Tahsil/Block Buxar Sadar of District Buxar of State Bihar.
Name: JASIM
Gender: male
Date of Birth: 30-APRIL-2008
Place of Birth: MUNICIPAL CORPORATION BUXAR
Name of Father: KASMUDDIN
Name of Mother: CHANDA
Permanent Address : GRAM DHILWARI PURAINI DATAGANJ BUDAUN UTTAR PRADESH 243635
Address of Parents at the time of Birth of Child : GRAM DHILWARI PURAINI DATAGANJ BUDAUN UTTAR PRADESH 243635
Registration Number: 44699/5/1590/2026
Date of Registration: 11-NOVEMBER-2025
Date of Issue: 11-NOVEMBER-2025
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"