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ee orm Noy 5 (See Rul 8) Serial Nol C. Register page Nos, 002429 Crest Govtg Punjab BIRTH CERTIFICATE _ it is certified that the following information obtained from the original Birth records which is entered in the register of loeal registrar Birth Tensil Dera Baba Nanak, Distt, Surdasmr for the year_2007. Name ~ Gurpreet Singh Registration No. 1 (one) Sex - le Date of registration ~ 301.2007 Place of birth - Arli Bhan Date of birth - 5,5,1990 Name of mother = Kuldeep Kaur Parents #111 ~ Village Nizarpap address Patti Arli Bhan P.O; Dangabad;) Tehsil Dera Baba Nanak J Distis Gurdasmuy Name of father = Raghbir Singh son of Mohinder Singh aa Signature of certificate issuer safe Saye Seal Panchayat Secretary-cum-Local Registrar Births and Deaths village Name _Piara Singh Nigarpura Patti Arli Phan Brock Hera Baba Nanak (Gurdaspur) Secretary- cumlLocal Registrar Date 20411,07 “rote = This birth certificate issued under Births and Deaths Registration Act 1969 (Govt) of India) section 12/175 attested to be true copy of document produced translated from Punjabi fu in Valid for Foreign Country — ‘Enalish Ooh aa" Embassy/High Commissioner. Notary Public, = T MAY / wb