Form-5
GOVERNMENT OF WEST BENGAL
DEPARTMENT OF HEALTH AND FAMILY WELFARE
DEBEN MAHATA GOVERNMENT MEDICAL COLLEGE AND
HOSPITAL
BIRTH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF BIRTH WHICH IS
THE REGISTER FOR DEBEN MAHATA GOVERNMENT MEDICAL COLLEGE AND HOSPITAL OF BLOCK/MUNICIPALITY MUNICIPALITY
PURULIA OF DISTRICT PURULIA OF STATE WEST BENGAL, INDIA.
NAME : SUBHA DIP BAURI GENDER : MALE
DATE OF BIRTH : 12/04/2019 PLACE OF BIRTH : DEBEN MAHATA GOVERNMENT MEDICAL
COLLEGE AND HOSPITAL, MUNICIPALITY
PURULIA, PURULIA, WEST BENGAL
NAME OF MOTHER : SONALI BAURI NAME OF FATHER : DIPAK BAURI
MOTHER'S IDENTITY PROOF : AADHAAR- FATHER'S IDENTITY PROOF : -
XXXXXXXX7274
PRESENT ADDRESS OF MOTHER STREET/LANE:- RENI ROAD,VILLAGE/TOWN:- PURULIA,MUNICIPALITY PURULIA MUNICIPALITY,DIST:-
AT THE TIME BIRTH OF THE PURULIA,WEST BENGAL-
CHILD :
PERMANENT ADDRESS OF STREET/LANE:- RENI ROAD,VILLAGE/TOWN:- PURULIA,MUNICIPALITY PURULIA MUNICIPALITY,DIST:-
MOTHER : PURULIA,WEST BENGAL-
CERTIFICATE NO : B-2019: 19-90087- DATE OF REGISTRATION : 15/04/2019
000760
S-UHID : 77084437304157 REMARKS (IF ANY) :
DATE OF ISSUE : 15/04/2019 ISSUING AUTHORITY :
UPDATED ON : 2022-08-13 07:32:46
Signature Not Verified
Digitally Signed.
Name: NAYAN MUKHOPADHYAY
Date: 12-Jun-2023 10:59:32
REGISTRAR (BIRTH & DEATH)
DEBEN MAHATA GOVERNMENT
MEDICAL COLLEGE AND HOSPITAL
"THIS IS A COMPUTER GENERATED CERTIFICATE."
THE [Link] INDIA VIDE CIRCULAR NO. 1 / 12 / 2014 - VS(CRS) DATED 27 - JULY - 2015
HAS APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES
"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "
