Key No. B0070167-1005285 FORM No.

5
(See Rule 8)

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GOVERNMENT OF KERALA

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DEPARTMENT OF URBAN AFFAIRS kn^nv \Ip Xtim]\ns t]cv Xncph\]pcw tImtdj Name of Local Government issuing certificate Thiruvananthapuram Corporation

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BIRTH CERTIFICATE
(Issued Under Section 12)

(1969se P\\acW cPnkvt{Sj BIvSnse 12mw hIppw 1999se tIcf P\\acW cPnkvt{Sj Nfnse 8mw Nhpw A\pkcnv \IpXv).
(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)

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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) Thiruvananthapuram Corporation of Taluk Thiruvananthapuram of District Thiruvananthapuram of State Kerala.

---t]cv/ Name ---B/s]/ Sex ---P\\ XobXn/ Date of Birth ---P\\ ew/ Place of Birth

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Um tPmPv sPn / DAN GEORGE JESTIN B/ Male

21/05/2010 TWENTY ONE/MAY/TWO THOUSAND TEN

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Kerala Institute Of Medical Sciences (KIMS), Thiruvananthapuram

---amXmhns t]cv / Name of Mother ---]nXmhns t]cv/ Name of Father IpnbpsS P\\ kabv amXm]nXmfpsS tahnemkw Address of the parents at the time of birth of the child amXm]nXmfpsS ncamb tahnemkw Permanent address of parents cPnkvt{Sj \/ :
Registration Number 13115/2010

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Pn adnbw Pn / GEEN MARIAM JESTIN Pn KohKokv / JESTIN GEEVARGHESE Bimcntbv hoSv, Nmppg , NqctmSv ]n H, ASq, ]\wXn, tIcfw, CUy
Assariathu House, Chathnnopuzha, Choorakodu P O, Adoor, Pathanamthitta, Kerala, India

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Assariathu House, Chathnnopuzha, Choorakodu P O, Adoor, Pathanamthitta, Kerala, India

cPnkvt{Sj XobXn/ : 29/05/2010

Date of Registration :

---A`n{]mbpdnv/ Remarks (if any)

---\Ip XobXn/ Date of Issue \Ip A[nImcnbpsS tahnemkw/

Address of the issuing authority

28/01/2013 (13:37)

Last Updated on 04/08/2010 (11:52)

Registrar of Births and Deaths , Thiruvananthapuram Corporation

Ensure Registration of Every birth and death

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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 www.cr.lsgkerala.gov.in. 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 Page 1/1