FAL305X
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) Madhubani Municipal Corporation
of Tahsil/Block Madhubani Sadar of District Madhubani of State Bihar.
Name: Suneeta
Gender: female
Date of Birth: 01-JANUARY-1989
Place of Birth: DHANGA, MADHUBANI, BIHAR
Name of Father: Kaushalendra Pratap
Name of Mother: Madhuri
Permanent Address : GRAM-KATHIYA, DHANGA, MADHUBANI, BIHAR-847229
Address of Parents at the time of Birth of Child : GRAM-KATHIYA, DHANGA, MADHUBANI, BIHAR-847229
Registration Number: 74315/7/4017/2026
Date of Registration: 04-JULY-2009
Date of Issue: 13-SEPTEMBER-2010
Signature of Issuing Authority
"Ensure Registration of Every Birth and Death"