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Government of Bihar Government of Bihar Government of Bihar: Birth Birth Certificate

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FORM NUMBER – 5 F5M9T7

[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
Death 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) Gaya Municipal Corporation
of Tahsil/Block Gaya of District Gaya of State Bihar.
Name : MOHAMMAD HUSSAIN

Gender : Male

Date of Birth : 16-January-2017

Place of Birth : Gaya

Name of Father : Shafique Ahmed

Name of Mother : Farzana Aslam

Permanent Address : Aliganj, Road No-3, City-Gaya,


Gaya, Dist – Gaya, State-Bihar,
India

Address of Parents at the time : Aliganj, Road No-3, City-Gaya,


Gaya, Dist – Gaya, State-Bihar,
of Birth of Child India

Registration Number : 12559/1/7428/2017

Date of Registration : 19-June-2017

Date of Issue : 19-June-201


2017 Signature of Issuing authority

36879/0 Seal

“Ensure Registration of Every Birth and Death”

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