GOVERNMENT OF ODISHA DEPARTMENT OF HEALTH AND FAMILY WELFARE BISWANATHPUR 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 BISWANATHPUR CHC of Tahasil CHHATAPUR of District SUPAUL of State ODISHA Dr Pradosh Kumar Panda Issuing Authority Registrar, Births & Deaths BISWANATHPUR CHC id="tk_1" class="t s6">(English Version) FORM NO-5 ISSUE NO : 143/2026 NAME: SARVALA KUMARI SEX: FEMALE DATE OF BIRTH: 01-01-2005 PLACE OF BIRTH: WARD NO 01, SOHTA, GIRDHARPATTI, SUPAUL, BIHAR, 852137 NAME OF MOTHER: LALO DEVI NAME OF FATHER: CHANDAN KUMAR MOTHER'S ID PROOF NO: ******** FATHER'S ID PROOF NO: ******** ADDRESS OF PARENT AT THE TIME OF CHILD BIRTH: WARD NO 01, SOHTA, GIRDHARPATTI, SUPAUL, BIHAR, 852137 PERMANENT ADDRESS: WARD NO 01, SOHTA, GIRDHARPATTI, SUPAUL, BIHAR, 852137 REGISTRATION NO: 1490/2026 REGISTRATION DATE: 05-08-2022 UBRN NO: 21UB370-0017-001751-2021 DATE OF ISSUE: 05-08-2022 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: 05-08-2022 Reason: Birth Certificate Location: SUPAUL Signature Not Verified