Key No.

B0060526-2010152
FORM No.5
(See Rule 8)
tIcf kÀ¡mÀ
GOVERNMENT OF KERALA
]©mb¯v hIp¸v
DEPARTMENT OF PANCHAYAT
kÀ«n^n¡äv \ðIp¶ Xt±iØm]\¯nsâ t]cv `cW§m\w {Kma ]©mb¯v
Name of Local Government issuing certificate Bharananganam Grama Panchayat
P\\ kÀ«n^n¡äv
BIRTH CERTIFICATE
(Issued Under Section 12)

(1969þse P\\þacW cPnkvt{Sj³ BIvSnse 12þmw hIp¸pw 1999þse tIcf P\\þacW cPnkvt{Sj³ N«§fnse 8þmw
N«hpw A\pkcn¨v \ðIp¶Xv).
(Issued under Section 12 of the Registration of Births and Deaths Acts, 1969 and Rule 8 of the Kerala Registration of Births and Deaths
Rules, 1999)
Xmsg ]dbp¶ hnhc§Ä tIcf kwØm\¯nse tIm«bw Pnñbnse ao\¨nð Xmeq¡nse `cW§m\w {Kma ]©mb¯v
þse (Xt±iØm]\w) AÊð P\\ cPnÌdnð \n¶v FSp¯n«pÅhbmsW¶v km£ys¸Sp¯p¶p.
This is to certify that the following information has been taken from the original record of birth which is the register for (local area/local
body) Bharananganam Grama Panchayat of Taluk Meenachil of District Kottayam of State Kerala.
---t]cv/ Name : s_tYð Cks_ð sað_nð / BETHEL ISABEL MELBIN
---B¬/s]¬/ Sex s]¬/ Female
:
---P\\ XobXn/ Date of Birth : 15/10/2020
FIFTEEN/OCTOBER/TWO THOUSAND TWENTY
---P\\ Øew/ Place of Birth :
C½m¡pteäv lmÀ«v Hm^v tacn tlmkv]näð, `cW§m\w/

Immaculate Heart of Mary Hospital, Bharananganam

---amXmhnsâ t]cv / Name of Mother AtPman acnb tPmk^v / AJOMY MARIA JOSEPH
:
---]nXmhnsâ t]cv/ Name of Father
: sað_n³ tPmÀPv / MELBIN GEORGE
Ip«nbpsS P\\ kab¯v : hSt¡S¯v lukv, ImfnbmÀ ]n.H, sXmSp]pg, ]n³þ685607, CSp¡n,
amXm]nXm¡fpsS taðhnemkw tIcfw, C³Uy
Address of the parents at the time of : Vadakkedath House, Kaliyar P.O, Thodupuzha, Pin-685607, Idukki, Kerala, India
birth of the child
amXm]nXm¡fpsS Øncamb : hSt¡S¯v lukv, ImfnbmÀ ]n.H, sXmSp]pg, ]n³þ685607, CSp¡n,
taðhnemkw tIcfw, C³Uy

Permanent address of parents : Vadakkedath House, Kaliyar P.O, Thodupuzha, Pin-685607, Idukki, Kerala, India

cPnkvt{Sj³ \¼À/ : 646/2020 cPnkvt{Sj³ XobXn/ : 22/10/2020

Registration Number Date of Registration
---A`n{]mb¡pdn¸v/ Remarks (if any) :

---\ðIp¶ XobXn/ Date of Issue : 22/10/2020 (15:51) Last Updated on 22/10/2020 (15:35)

\ðIp¶ A[nImcnbpsS taðhnemkw/

: Registrar of Births and Deaths ,
Address of the issuing authority
Bharananganam Grama Panchayat

“Ensure Registration of Every birth and death”

“Hmtcm P\\hpw acWhpw cPnÌÀ sNbvXpsh¶v Dd¸phcp¯pI”
This certificate is computer generated and does not require any Seal/Signature in original
The Govt. vide G.O.(Ms) No.202/2012/LSGD dated 25/07/2012 has approved this certificate as a valid document for all official purposes
Authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
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