This is to certify that the following information has been taken from the original record of birth, which

is the register
for (local areas)
of Tahasil
of District
of State of Odisha.
Name Name of Mother
Sex Permanent Address of Parents
Date of Birth
Place of Birth
Name of Father
Registration No.
Date of Registration
Signature of Issuing Authority
Seal
FORM NO. 8
(See Rule 8)
APPLY FOR BIRTH CERTIFICATE
(Issued under Section 12)
Date
Housing & Urban Development Department
Government of Odisha

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