Key No.

B0070964-9831960223
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
\KcImcy hIp¸v
DEPARTMENT OF URBAN AFFAIRS
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv Xncqc§mSn ap\nkn¸menÁn
Name of Local Government issuing certificate Tirurangadi Municipality
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(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)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse ae¸pdw Pnñbnse Xncqc§mSn Xmeq¡nse Xncqc§mSn ap\nkn¸menÁn
þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
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) Tirurangadi Municipality of Taluk Tirurangadi of District Malappuram of State Kerala.
---t]cv/ Name : SAYYID SHAHID.V.T
---B¬/s]¬/ Sex B¬/ Male
:
---P\\ XobXn/ Date of Birth : 09/03/1998
NINE/MARCH/ONE THOUSAND NINE HUNDRED NINETY EIGHT
---P\\ Øew/ Place of Birth :
sImïmW¯v Bip]{Xn , sN½mSv/

Kondanath Hospital, Chemmad

---amXmhnsâ t]cv / Name of Mother Shereefa Beevi K.K
:
---]nXmhnsâ t]cv/ Name of Father
:
Sayed Muhammed Anwar Thangal V.T
Ip«nbpsS P\\ kab¯v : *** e`yañ
amXm]nXm¡fpsS taðhnemkw

Address of the parents at the time of : *** Not Available

birth of the child
amXm]nXm¡fpsS Øncamb : tcJs¸Sp¯nbn«nñ
taðhnemkw

Permanent address of parents : Kassi (H) Ponmundam (PO) Tirur Via Malappuram Dt

cPnkvt{Sj³ \¼À/ : 943/1998 cPnkvt{Sj³ XobXn/ : 19/03/1998

Registration Number Date of Registration
*** AÊð tcJIfnð Ip«nbpsS P\\ kab¯v amXm]nXm¡fpsS taðhnemks¯
---A`n{]mb¡pdn¸v/ Remarks (if any) : kw_Ôn¨ tImf§Ä DÄs¸Sp¶nñ

*** The original records do not contain the column relating to the address of the parents at
the time of birth of the child.
---\ðIp¶ XobXn/ Date of Issue : 14/09/2018 (10:40) Last Updated on 02/04/2013 (15:25)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Tirurangadi Municipality

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
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
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