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NO. 1

FORM-5

GOVERNMENT OF UTTAR PRADESH

NirT TT TET f T

DEPARTMENT OF MEDICAL AND HEALTHH

CANTONMENT DOARD, KANPUR(CB)

BIRTH CERTIFICATE

T

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stefra, 1969

12 17 7I 3R7*

ry farzru faua, 2002 farun 8/13

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ISSUED UNDER SECTION12/17 OF THE REGISTRATION OF BIRTHS & DEATHS AT, 1969 AND RULE 8/13 OP THE UTTAR PRADESH REGISTRATION OF BIRTHS&DEATHSRULES 2002)

THSIS TOCERTIYTHATTHEFOLLOWING INFORMATION HAS BEEN TAKEN FROM THEORIGINAL RECORD OF BIRTHWHICH IS THE REGISTERFOR CANTONMENT BOARD, KANPURICB) OF TAHSILBLOCK KANPUR OF DISTRICT KANPUR NAGAR OF STATE/UNION TERRITORY UTTARPRADESH, INDIA TR/NAME: SHREENIKA AWASTHI / TA FTTt

FAT SEX: HÍKT/FEMALE

TafDATE OF BIRTH: 16-01-20155

TFHFT PLACE OF BIRTH: 7AIRFORCE HOSPITAL CANTT. KANPUR/

SDXTEENTH-JANUARY-TwO THOUSAND FIFTEEN

TAITA NAME OF MOTHER: SWATIaTt ATAT

qTEST

HT

TA

/NAME QF FATHER:

SHOBHITAWASTHI

T / MOTHER'S UID NO:

fY7

AA Hetet

7TEST T / FATHER'S UID NO:

4270 2879 0076 T R qH TAT-AT BIRTH OF THE CHILD: 117/Q/443 SHARDA NAGAR

NAVEEN NAGAR

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ADDRESS OF PARENTS AT THE TIME OF

KANPUR (CB), KANPUR KANPUR NAGAR.

UTTAR PRADESH

TTATT, T

(4), TT, THTT AT,

TaTr g REGISTRATION NUMBER: B-2017:9-90373-000589

HTAT-fA1 TTd YATI PERMANENT ADDRESS OF PARENTS 117/0/443 SHARDA NAGAR, NAVEEN NAGAR, KANPUR (CB), KANPUR UTTAR PRADESH

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KANPUR NAGAR

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,

Tsta7 TTE/ DATE OF REGISTRATION: 03-08-2017

fzoqot/REMARKS (IF ANY): R-72 B-1795 DT. 30-01-2015

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fafa/

03-08-2017

DATE OF ISSUE:

ar

aTeT

ATTeATd

ISSUING AUTHORIY

REGISTRAR (BIRTH & DEATH)

CANTONMENT BOARD, RANPUR(CB)

UPDATED ON

03-08-2017 11:28:27

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THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURB-ORMESSUING AUTHORITY THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HASS APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES'

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teru f e a t

ENSU RE REGISTNATHON OP EVERY HIRTH AND DENTm°

3TET

LUniaua ldontilicalion Authorily oflodia

Government of India Enrolment No. 0654/07043/01937 To

Shreenika Awasthi D/0: Shobhit Awasthi SHARDA NAGAR Naveen Nagar Naveen Nagar

Kanpur Nagar Uttar Pradesh 208025

9765412763

Signabura N o Verified

ATHCETe NOA

3T95 3HTETT 5HT/ Your Aadhaar No.

6038 8968 5599

Government of India Shreenika Awasthi

Date of Birth/DOB: 16/01/2015 Female/ FEMALE

6038 8968 5599