Ys\½}FORM - 5
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GOVERNMENT OF GUJARAT
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DEPARTMENT OF HEALTH AND FAMILY WELFARE
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BIRTH CERTIFICATE
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(Issued under Section 12/17 of the Registration of Birth and Death Act,1969
.
and Rule 8 of the Gujarat Registration of Birth and Deaths Rules 2018)
8Tj̆\hRjSD^ah\h58apJpD°WjIpWj\heSjKƛ\WhȺl`^°DP½\h5Tj_pah\h58ajJpȐ[h^SWhȤkK^hS^hԌ]Wh[haWF^Kƣ_hWh
[haWF^ShɀkDhWh[haWF^˴h\be°^Wh^KƨN^\h5Jp
This is to certify that the following information has been taken from the original record of birth which is in the register for Village/City
Bhavnagar(C) of Taluka Bhavnagar(C) of District Bhavnagar of Gujarat State, India.
Wh\Name : / ĤiSSex : ڧڔἘڟMale
Zh`DȵkʠkĮWh\: Child's Full Name
Kƛ\Sh^EDate of Birth : 30/05/2025 Kƛ\ƨT`Place of Birth :
Friday, May 30, 2025 NEER WOMENS HOSPITAL
\hShȵk5Wh\Name of Mother : iXShȵk5Wh\Name of Father :
ڤڀڤڕڙڇڧڡڑژڡژڧړڤږڤڠڀٳἓAKSABANU MAHMADHUJYAFA \e\UɆkK]Yh7_[h:DhĥMAHMADHUJYAFA ALIBHAI KAJI
KAJI
Zh`DWhKƛ\d\]p\hShiXShȵk5d^WhȺk5Address of parents \hShiXShȵk5Dh]\jd^WhȺk5Permanent Address of
at the time of Birth of child : Parents :
KAJI ALIBHAI, SAGAR CUTPIC,MADHAV CHAMBERS, KAJI ALIBHAI, SAGAR CUTPIC,MADHAV CHAMBERS,
PIRCHHALLA ROAD, BHAVNAGAR / ڤڀἓښڂڤڠٶڤڗڛڥٳ PIRCHHALLA ROAD, BHAVNAGAR ڤڀἓڠڦڔڊڀښڂڤڠٶڤڗڛڥٳ
ڬڅڝڒڤژڠڦڔڊڀḒڠږ᷷چښڔڥḕښڂړڝڤڗڌڮښڤڛ ڬڅڝڒڤژḒڠږ᷷چښڔڥḕښڂړڝڤڗڌڮښڤڛ
WҭVRj˲\h5DRegistration No. : 7194 WҭVRjWjSh^ERegistration Date : 24/06/2025
^\hD½d iabpcWҭV Remarks (if any) : ̆\hRX́W5Z^Certificate No. : B202510470953
/0
̆\hRX́DhQ8Ɯ]hWjSh^EDate of issue : ̆\hRX́8XWh^dĂhiVDh^WjdeSignature of Issuing
Authority :
24/06/2025 ..................................................................................
Registrar ( Birth & Death )
^Kƨ˼h^ Kƛ\\^R
Bhavnagar(C) , Bhavnagar
rodKaIMeOK5v/zOz65RdfcDKac/Ux7GDcodUAomyMAwCTakIaqGHDnYX9BSrrryi
Disclaimer : This is a computer generated extract of birth register. In case of any objection, please contact concerned Registrar (B&D).