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No.

0072874
FORM 5
(See Rule 9of West Bengal Registratlon of Births and Deaths Rules, 2000)

Government of West Bengal Department of Health & Famlly Welfare

CERTIFICATE OF BIRTH
(2HT)
582
(lssued under Sec. 12/Sec. 17 of the Registration of Births and Deaths Act, 1969)

This is to
certify that the following informatlon has been taken from the original record of birth which is in the
register for KOLKATA MUNICIPAL CORPORATION of Alipore
P.S.

KOLKATA District of West Bengal.

Name SHIVANYA CHAKRABORTY Registration No. I/09/2017/03285


(ATA) (OLD RE GN. NO : 330811)

Sex (M/F) 09/12/2017


FEMALE Date of Registration:
6/18 fm(P/ (CTTuAN)

Date of Birth
23/10/2017
( TRN)

Place of Birth THE CALCUTTA MEDICAL RESE ARCH INSTITUTE KOL27


) BOROUGH- IX

Name of Father SHUVAJOY CHAKRABORTY


(TeTR )
PRIYANKA CHAKRABORTYoA
Name of Mother
(ATOT T) NU-MANS PARK, FO PAILANHAT. CHAK RAJU MoLLA. PS
BISHNUPUR, 24 PGS (S) KOLKATA 7001
Pemanent Address
of Parents NU-MANS PARK. POo PAILANHAT. CHAK RAJU MotLA. PS
BISHNUPUR 24 PGS (S), KOL KATA 700104

Address of Parents at the 0gPALCORPORATO


time of birth of the child DicPAL CORpORATO
oPALCOReD
Signature of the lssuing Authority
CRAL CORRA WitiFdt
MCPAL CORBORAROKTHE KOE (DiN e)
08/09/2018Place of CcosroR BR IX PABOtor¥ Kol-27
Date of lssue of Issue: Type 11, belvedere Rood.
(TtA UIR) (eTtRR)OR
ON THR

JULY 2018
CKBIRLA HOSPITALS | CMRI

To Dt.01.09.2018
HEALTH OFFICER
K. M. C
KOLKATA

Sir,
This is to inform you that Patient Mrs Priyanka Chakraborty
w/o Mr.Shuvajoy Chakraborty admit ted in this Institute and
delivered one living Female Baby.Pana No-25538.The Particulars
of the Baby are as follows:

1. Date of Birth 23.10.2017

2.Time of Birth 08:13 A.M.

3.Sex Female

4.Weight 2. 37 Kgs

So, please do the needful.

Thanking you,

Yours faithfully,
for The Calcut ta Medical Research Instt .

(M.RDFDeptt)
estic

The Calcutta Medical Research Institute


7/2 Diamond Harbour Road, Kolkata 700027, India
+91 33 3090 3090 [email protected] www.ckbirlahospitals.com

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