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.RAMPUR 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: CHUMUKILA MAJHI SEX: FEMALE DATE OF BIRTH: 20/01/2013 PLACE OF BIRTH: T.RAMPUR NAME OF MOTHER: UMBUR MAJHI NAME OF FATHER: LAICHAN MAJHI MOTHER'S ID PROOF NO: ********3699 FATHER'S ID PROOF NO: ********2455 ADDRESS OF PARENT AT THE TIME OF CHILD BIRTH: AT-SIALIPADAR,PO-GUNPUR,TH.RAMPUR,KALAHANDI PERMANENT ADDRESS: AT-SIALIPADAR,PO-GUNPUR,TH.RAMPUR,KALAHANDI REGISTRATION NO: 8750/2025 REGISTRATION DATE: 07-03-2025 UBRN NO: 21UB370-0017-001751-2021 DATE OF ISSUE: 09-07-2025 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: 09-07-2025 Reason: Birth Certificate Location: KALAHANDI Signature Not Verified