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7758 2022 Certificate

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(English Version) FORM NO-5

ISSUE NO : 12839/2022

GOVERNMENT OF ODISHA

DEPARTMENT OF HEALTH AND FAMILY WELFARE

Bhawanipatna Municipal Council

CERTIFICATE OF BIRTH
Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and 8/13 Rule of the Odisha
Registration of 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 Bhawanipatna Municipal Council of Tahasil BHAWANIPATNA
of District KALAHANDI of State ODISHA

NAME: ARSHIV BHARADWAJ SEX: MALE

DATE OF BIRTH: PLACE OF BIRTH:


30/10/2022 MAA MANIKESWARI MULTISPECIALITY HOSPITAL,
BHAWANIPATNA

NAME OF MOTHER: NAME OF FATHER:


RUCHISMITA PADHI CHHATRAPATI BHARADHWAJ

MOTHER'S ID PROOF NO: FATHER'S ID PROOF NO:

ADDRESS OF PARENT AT THE TIME OF CHILD PERMANENT ADDRESS :


BIRTH:AT-PODAGUDA, PO-KHALIABHATA, PS- AT-PODAGUDA, PO-KHALIABHATA, PS-JAIPATNA,
JAIPATNA, KALAHANDI, ODISHA, INDIA KALAHANDI, ODISHA, INDIA

REGISTRATION NO: REGISTRATION DATE:


7758/2022 01/11/2022

UBRN NO: DATE OF ISSUE:


21UB358-0016-007758-2022 29/11/2022

Signature Not Verified Dr Ranjan Mitra


Digitally signed by RANJAN Issuing Authority
MITRA
Date: 2022.11.29 08:11:37 IST Registrar, Births & Deaths
Reason: Birth Certificate
Location: BHAWANIPATNA BHAWANIPATNA MUNICIPAL COUNCIL

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.in Tampering of this certificate will attract
penal action.

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