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 Tahasilof Districtof State of Orissa.NameName of MotherSexPermanent Address of ParentsDate of BirthPlace of BirthName of FatherRegistration No.Date of RegistrationSignature of Issuing AuthoritySealFORM NO. 8(See Rule 8)APPLY FOR BIRTH CERTIFICATE(Issued under Section 12)Date Housing & Urban Development DepartmentGovernment of Orissa Published on National Portal of India (india.gov.in)
