BIRTH CERTIFICATE
GOVERNMENT OF HARYANA
PUBLIC HEALTH DEPARTMENT
(Under Section 12/17 of the Birth and Death Registration Act, 1969)
Form No 5 (Nigam 8)
It is hereby certified that following Information has been taken from the original
record of birth, Which is in the register of Village/City Machhroli Tehsil Samalkha District
Panipat
1. Name:- NIDHI 2. Sex of Child:- FEMALE
3. Birth Date:- 28-05-2003 4. Birth Place :- MACHHROLI
5. Date of Birth (in word) TWENTY EIGHT MAY TWO THOUSAND THREE
6. Registration No.:- 17 7. Registration Date:- 04-06-2003
8. Father’s Name:- JITENDER 9. Mothers’ Name :- POONAM
10. Permanent Address of mother/father:- MACHHROLI
DATED:
Signature of Issuing Authority
Form No.5
(See Rule 8)
BIRTH CERTIFICATE
GOVERNMENT OF HARYANA
HEALTH DEPARTMENT
Certificate Issued Under Section 12 of Registration of Birth and Death Rule 1969.
This is certified that below given information has been taken from the birth record of
Samalkha Distt. Panipat , State Haryana of INDIA.
Name : Shani
Sex : Female
Date of Birth : 01-02-2009
Place of Birth : Village:- Bhodwal Majri, Tehsil Samalkha
Distt.:- Panipat (Haryana)-INDIA
Father’s Name : Sunil Dutt
Mother’s Name : Poonam
Registration Number : 76
Date of Registration : 04-02-2009
Permanent Address : Village Bhodwal Majri
, Tehsil Samalkha
Distt. Panipat (Haryana)-INDIA
DATE OF ISSUE : 04-02-2009
Signature of Issuing Officer
THIS CERTIFICATE IS ONLY FOR INFORMATION AND NOT VALID FOR
LEGAL PURPOSE
Form No.6
( See Rule 8)
DEATH CERTIFICATE
GOVERNMENT OF HARYANA
DEPARTMENT OF HEALTH
Death Certificate Issued Under Section 12 of Registration of Birth and Death Act,
1969.
It is certified that following Information has been taken from the original record of
death, Which is in the register of (Local Area ) Municipal Committee Samalkha of
Tehsil Samalkha District PANIPAT State: HARYANA
Name: Dalel Singh
Gender Male
Date of Death 04-03-2013
Place of Death Samalkha
Father/Husband’s Name Sher Singh
Mother’s Name
Registration Number 40
Registration Date 08-03-2013
Permanent Address Ward Number 7 , Mohalla Kali Ramna,
Samalkha
DATED: 08-03-2013 Signature of Issuing Authority
Seal
Form No.5
( See Rule 8)
BIRTH CERTIFICATE
GOVERNMENT OF HARYANA-INDIA
DEPARTMENT OF HEALTH
Birth Certificate Issued Under Section 17 of Registration of Birth and Death Act, 1969 It is
certified that following Information has been taken from the original record of birth, Which is in
the register of (Local Area ) Panchkula District Panchkula State Haryana (INDIA).
District: PANCHKULA State: HARYANA
Surname: SINGH Sex: Male
Given Name: SAKSHAM
Date of Birth: 03-07-2004 Place of Birth: PANCHKULA
Registration Number: 320 Regn. Date: 03-07-2004
Father’s Name: SATISH SINGH
Name of Mother: SUCHIETA KUHAAR
Permanent Address of Father/Mother:- House No. 500, Sector 20 (Part-2) Panchukla , Haryana-
India
DATED: Signature of Issuing Authority
Seal
Form No.5
( See Rule 8)
BIRTH CERTIFICATE
GOVERNMENT OF HARYANA
DEPARTMENT OF HEALTH
Birth Certificate Issued Under Section 17 of Registration of Birth and Death Act, 1969
It is certified that following Information has been taken from the original record of birth, Which
is in the register of (Local Area ) Panchkula District Panchkula State Haryana (INDIA).
District: PANIPAT State: HARYANA
Name: SEEMA CHHOKAR Sex: Female
Date of Birth: 25-09-1986 Place of Birth: DHODPUR
Registration Number: D-139 Regn. Date: 25-11-2014
Father’s Name: Sh. JAGDISH CHHOKAR Name of Mother : Smt. KUSUM DEVI
Permanent Address of Father/Mother:. Village Dhodpur Tehsil Samalkha Distt. Panipat
(Haryana)-INDIA
Date of birth (Words) :- TWENTY FIVE SEPTEMBER NINETEEN HUNDRED NINETY SIX .
DATED: Signature of Issuing Authority
Seal
Form No.5
(See Rule 8)
BIRTH CERTIFICATE
GOVERNMENT OF HARYANA
HEALTH DEPARTMENT
Certificate Issued Under Section 12 of Registration of Birth and Death Rule 1969.
This is certified that below given information has been taken from the birth record of
Samalkha Distt. Panipat , State Haryana of INDIA.
Name : Prince Sehrawat
Sex : Male
Date of Birth : 29-04-2007
Place of Birth : Village:- Karhans, Tehsil Samalkha
Distt.:- Panipat (Haryana)-INDIA
Registration Number : 273-D
Date of Registration : 03-09-2009
Father’s Name : Sunehra
Mother’s Name : Reena Devi
Permanent Address : Village Karhans , Tehsil Samalkha
Distt. Panipat (Haryana)-INDIA
DATE OF ISSUE : 03-09-2009
Signature of Issuing Officer
Form No.5
( See Rule 8)
BIRTH CERTIFICATE
GOVERNMENT OF HARYANA
DEPARTMENT OF HEALTH
Birth Certificate Issued Under Section 17 of Registration of Birth and Death Act, 1969
It is certified that following Information has been taken from the original record
of birth, Which is in the register of (Local Area ) Karhans of Tehsil Samalkha..
District: PANIPAT State: HARYANA
Name: Nishant Sehrawat Sex: Male
Date of Birth: 16-06-2008 Place of Birth: Karhans
Registration Number: 5205 Regn. Date: 01-07-2008
Father’s Name: Sh. Sunehra
Permanent Address of Father/Mother: Vill. Karhans Tehsil Samalkha Distt. Panipat.
Name of Mother : Smt. Reena Devi
Date of birth (Words) : SIXTEENTH JUNE TWO THOUSAND FIVE.
DATED: 29-07-2008 Signature of Issuing Authority
Seal
BIRTH CERTIFICATE
(Under Section 12/17 of the Birth and Death Registration Act, 1969
GOVERNMENT OF HARYANA
Form No. 9
PUBLIC HEALTH DEPARTMENT
It is hereby certified that following Information has been taken from the original
record of birth, Which is in the register of Village/City ________________________ Taluka
_________________ District _____________
1. Name:- 2. Sex of Child:- (M/F)
3. Birth Date:- 4. Registration No.:-
5. Birth Place :- 6. Date of Registration
7. Mother’s Name:- 8. Father’s Name :-
9. Address of mother/father --------------------------
Remarks:- Name of name of child should be got recorded within one year of birth registration,
after expiry of time limit late fee Rs. 2.00 will have to paid.
DATED:
Signature of Issuing Authority This is true and correct Translation of the
Sd/- illegible Original Document from Hindi in to English
Compared with Original Document
By Me