UPJMN Form-3

People’s Republic of Bangladesh

Office of the Registrar of Birth and Death

No.1, Rajapur Union Council

Police Station: Burichong, District: Comilla, Bangladesh

BIRTH CERTIFICATE

[Rule-9, of Birth and Death Registration (Union Council) Rules, 2006]

(Extract from Birth Register)

Register Book No.

002

Date of Registration:-

30   /  12  / 2007 Day  Month  Year

Registration No.

0

0

7

8

1

4

Date of issue:-

24   /  11 / 2010 Day  Month  Year

Personal Identification No.

1

9

9

3

1

9

1

8

7

5

1

0

0

7

8

1

4

Name:-    Riazul Islam

√

Date of Birth (AD):    (In Digit):- 15-05-1993 A.D        Sex:- �  Female   �  Male

                                        (In words):-  Fifteen May Nineteen Hundred Ninety Three

Place of Birth:-           Village- Charanal               Post office:- Charanal

Police station:            Burichong   District:- Comilla, Country: Bangladesh.

Father’s Name:-         Late Siddiqur Rahman                   Nationality:- Bangladeshi

Mother’s Name:-        Salehabegum                     Nationality:-  Bangladeshi

Permanent Address:  Village: Charanal, Post Office: Charanal

                                       Police Station: Burichong, District- Comilla, Bangladesh

(Signature and Name of Prepare with Seal)

(Signature and Name of Registrar with Seal)