GOVERNMENT OF ODISHA DEPARTMENT OF HEALTH AND FAMILY WELFARE TH.RAMPUR CHC CERTIFICATE OF BIRTH Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and Rules of Odisha Births and Deaths, Rule 2001 This is to certify that following information has been taken from the original records of birth which is in the register for TH.RAMPUR CHC of Tahasil T.EAMPUR of District KALAHANDI of State ODISHA Dr Pradosh Kumar Panda Issuing Authority Registrar, Births & Deaths TH.RAMPUR CHC id="tk_1" class="t s6">(English Version) FORM NO-5 ISSUE NO : 143/2026 NAME: JAYA MAJHI SEX: MALE DATE OF BIRTH: 19/05/2008 PLACE OF BIRTH: CHC TH.RAMPUR NAME OF MOTHER: WANADEI MAJHI NAME OF FATHER: MADING MAJHI MOTHER'S ID PROOF NO: ********4065 FATHER'S ID PROOF NO: ******** ADDRESS OF PARENT AT THE TIME OF CHILD BIRTH: NAKRUNDI,TH.RAMPUR,KALAHANDI,ODISHA,INDIA PERMANENT ADDRESS: NAKRUNDI,TH.RAMPUR,KALAHANDI,ODISHA,INDIA REGISTRATION NO: 8189/2025 REGISTRATION DATE: 05-08-2025 UBRN NO: 21UB370-0017-001751-2021 DATE OF ISSUE: 05-08-2025 THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FASCIMILE SIGNATURE OF THE ISSUING AUTHORITY. It is a digitally signed electronically generated certificate and therefore needs no ink-signed signature,stamp or seal. This certificate is issued as per section 4,5 & 6 of information technology Act 2000 and it's subsequent amendments in 2008.For any query or verification, please visit https://www.birthdeath.odisha.gov.inTampering of this certificate will attract penal action. Digitally signed by Dr Pradosh Kumar Panda Date: 05-08-2025 Reason: Birth Certificate Location: KALAHANDI Signature Not Verified