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