FORM NUMBER – 5 F5M9T7
[SEE RULE – 8]
GOVERNMENT OF BIHAR
DEPARTMENT OF PLANNING AND DEVELOPMENT
DIRECTORATE OF ECONOMICS AND STATISTICS
BIRTH CERTIFICATE
(Issued under Section – 12 of Registration of Births & Deaths Act, 1969 and Rule 8/13
of the Bihar Registration of Births and Deaths
Death Rules 1999)
This is to certify that the following information has been taken from the original record
of Birth which is the register for (Local Body) Gaya Municipal Corporation
of Tahsil/Block Gaya of District Gaya of State Bihar.
Name : MOHAMMAD HUSSAIN
Gender : Male
Date of Birth : 16-January-2017
Place of Birth : Gaya
Name of Father : Shafique Ahmed
Name of Mother : Farzana Aslam
Permanent Address : Aliganj, Road No-3, City-Gaya,
Gaya, Dist – Gaya, State-Bihar,
India
Address of Parents at the time : Aliganj, Road No-3, City-Gaya,
Gaya, Dist – Gaya, State-Bihar,
of Birth of Child India
Registration Number : 12559/1/7428/2017
Date of Registration : 19-June-2017
Date of Issue : 19-June-201
2017 Signature of Issuing authority
36879/0 Seal
“Ensure Registration of Every Birth and Death”