SRI LANKA

REGISTER OF BIRTH Birth and Death Registration Act (Cap. 110) District: Ampara No : 5126 Division : Panangkadu 28th of march(3) 1986(Eighty six) Government Hospital, Akkaraipattu Ahamadh Shadhi Male Full name Date of birth 4 Fathers Place of birth Race Rank of profession Name Date of birth 5 Mothers Place of birth Race age 6 Were parents married his name in full Mohamed Sharif Jaabir 4.8.1948 Akkaraipattu Sri Lankan Muslim Teacher Mohamed Mohideen Nahmathumma 25.7.1954 Akkaraipattu 6 Sri Lankan Muslim Thirty one Yes Ahamed Lebbe Mohamed Sharif

1 2 3

Date and Place of Birth Name Sex

his year of birth Not known his place of birth Akkaraipattu

8 If the father was Full name not born in Sri Lanka and if great grand father born Year of birth in Sri Lanka great grand Place of birth fathers 9 Informants full name and residence and in what capacity he gives information

Father Born in Sri Lanka Kathiripillai Ketheswaran Medical Officer Government Hospital Akkaraipattu
Registered under the deceleration envisaged in section 16

10

Informants signature

11 Date of registration

18th of April(4) 1986(Eighty six)

12 Registrars signature

K. Maheswaran

13 Name inserted or substituted

14 Name of person on whose information particulars relating to item 13 were supplied and in what capacity he gives information

15 Date of insertion or substitution and District Registrars or Registrar Generals signature

16

Childs birth order Assistant Government Agent Mothers permanent loving place

2nd Akkaraipattu Akkaraipattu

I do hereby certify that the foregoing is a true copy of a birth registration entry filed of record in this office P. Parasuraman Addl. District Registrar Aalayadivembu Date: 07th of April 2008

Signed by :