Key No.
B0070719-93010826115
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
]©mb¯v hIp¸v
DEPARTMENT OF PANCHAYAT
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv Nqïð {Kma ]©mb¯v
Name of Local Government issuing certificate Choondal Grama Panchayat
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)
(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse XrÈqÀ Pnñbnse Xe¸nÅn Xmeq¡nse Nqïð {Kma ]©mb¯v þse
(Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local
body) Choondal Grama Panchayat of Taluk Thalappilly of District Thrissur of State Kerala.
---t]cv/ Name : t]cv cPnÌÀ sNbvXn«nñ / Name Not Registered
---B¬/s]¬/ Sex B¬/ Male
:
---P\\ XobXn/ Date of Birth : 31/12/1992
THIRTY ONE/DECEMBER/ONE THOUSAND NINE HUNDRED NINETY TWO
---P\\ Øew/ Place of Birth :
skâv tPmk^vkv tlmkv]näð Nqïð, Nqïð/
[Link]’s Hospital Choondal, Choondal
---amXmhnsâ t]cv / Name of Mother joe [Link]. / Sheela K.V.
:
---]nXmhnsâ t]cv/ Name of Father
: tPmWn hn.H. / Johny V.O.
Ip«nbpsS P\\ kab¯v : *** e`yañ
amXm]nXm¡fpsS taðhnemkw
Address of the parents at the time of : *** Not Available
birth of the child
amXm]nXm¡fpsS Øncamb : hS¡q«v hoSv, ]mhd«n, XriqÀ, tIcfw, C³Uy
taðhnemkw
Permanent address of parents : Vadakkoott House, Pavaratty, Thrissur, Kerala, India
cPnkvt{Sj³ \¼À/ : 58/1993 cPnkvt{Sj³ XobXn/ : 08/01/1993
Registration Number Date of Registration
*** AÊð tcJIfnð Ip«nbpsS P\\ kab¯v amXm]nXm¡fpsS taðhnemks¯
---A`n{]mb¡pdn¸v/ Remarks (if any) : kw_Ôn¨ tImf§Ä DÄs¸Sp¶nñ
*** The original records do not contain the column relating to the address of the parents at
the time of birth of the child.
---\ðIp¶ XobXn/ Date of Issue : 04/03/2016 (08:53) Last Updated on 16/02/2015 (10:50)
\ðIp¶ A[nImcnbpsS taðhnemkw/
: Registrar of Births and Deaths ,
Address of the issuing authority
Choondal Grama Panchayat
“Ensure Registration of Every birth and death”
“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at [Link]. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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