ÊÊÊÊLœTÊß Form No.

5
ÊTŽIYÊâ>~ÊLXƫtB (See Rule 8)

IMY…JXžÊ6O˜
Government of Tamil Nadu
Municipal Administration & Water Supply Department
/

BIRTH CERTIFICATE - LŽP~©vÊDX}PYI…

(Issued Under Section 12/17 of the registration of Births and Deaths Act.1969 and Rule of 8 of Tamil Nadu Registration of Birth and Death Rules 2000)

This is to Certify that the following information has been taken from the original record of which is in the
register for of of Taluk of District of State
ÊÊÊÊÊÊÊBZ…BzGÊIBTƒB„ÊIMY…JXžÊMXJYQÊÊÊÊÊMXTyGÊÊTyGÊÊLŽƬºÊ<zÊÊ>Ê^Dƫ|IÊ
6DƒÊLŽP~©ÊLIY^TyœQY¯|¢Ê<žtB~LyG_TÊ<KÊDX}PYI…ÊTSuB~LžBY}P¢Ø

Name / ]LNƫ :

Sex / LXQYK :

Date of Birth / LŽP|IÊ^IIY :

Place of Birth / LŽP|IÊ8G

Name of Father / I|_INŽ}Ê]LNƫ :

UID Number of Father / I|_INŽ}Ê7IXƫÊ<z :

Name of Mother / IXNŽ}Ê]LNƫ :

UID Number of Mother/ IXNŽ}Ê7IXƫÊ<z :

Permanent Residential Address of the Parents / :

IX€ÊI|_INƬ}ÊJY_QNXKÊT“yžÊ«BTƬ

Address of the Parents at the time of Birth of the Child / :

”S|_IÊLŽP~LŽ}Ê^LX¢ÊIX€ÊI|_INƬ}Ê
«BTƬ

Registration Number / LIYºÊ<z :

Date of Registration / LIYºÊ]D€IÊ^IIY :

Remarks(If any) / :

Date of Issue / ^IIY : 18/Jan/2019

Signature and Address of Issuing Authority

DX}PYI…Ê6R~LTƬ}Ê_B]NX~L
Registrar, Birth & Death:

Ensure Registration Of Every Birth And Death LŽP~©ÊÙÊ8P~©~ÊLIYTŽ_KÊ:²IYÊ]D€T“ƫ

Certificate No :
Note:This Certificate is computer generated and does not require any seal/signature the authenticity of this certificate can be verified
https:// tnurbanepay.tn.gov.in .The Registration number is unique to each Birth.