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(EPGMONI FORMAR-3)

Government of the People’s Republic of Bangladesh

Office of Birth and Death Registration

06 No Maizbari Union Parishad

Upazilla- Kazipur, District- Sirajganj, Bangladesh

Birth Certificate

[Section- 9, Birth and Death Registration (Union Parishad) Regulation, 2006]

  (Quotation taken from birth registration book)

Registration Book No:

06

Registration Date	07	09	2014	Date of Certificate Issuance	07	09	2014
	Day	Month	Year		Day	Month	Year

Registration No

0

2

9

8

9

5

Personal Identification No

1

9

6

8

8

8

0

5

0

5

1

0

2

9

8

9

5

Name: Ayesha Parvin Maya

Birth Date: (In number AD)	01	01	1968	Sex:		Male	P	Female
		Mes	Año

In words (AD): One. One. Nineteen Hundred Sixty Eight AD

Birth place: Village- Datchi Meua Khola, Union- Maizbari

Upazilla- Kazipur     District- Sirajganj                                                  Country- Bangladesh

Name of Father: Late Alhaz Siddique Hossen Talukdar                          Nationality: Bangladeshi

Name of Mother: Late Rasheda Begum                                                 Nationality: Bangladeshi

Permanent Address:  Village- Bhatchi Meua Khola, Post Office- Dhulauri, Police Station- Bazipur, District- Sirajganj

6 No Maizbari Union Parishad Kazipur, Sirajganj (Seal of registration office)     Sd/ Illegible 07/09/2014 AD (Signature andname with seal of preparer) Jashon Kumar Shaon Enterpreneur UISB Information Service Center 06 No Maizbari Union Parishad

Sd/ Illegible 07/09/2014 AD (Signature and name with seal of registration) Talukdar Jahangir Alam Chairman 6 No Maizbari Union Parishad Kazipur, Sirajganj