Certified English Translation
A11474/05-11-03
e Registration B1
(High Reg. P&SC)278
No. 6455
SRILANKA
CERTIFICATE OF BIRTHS
Births and Deaths Registration Act (Cap. 110)
District:- Kalutara
Division: Kalutara Town
1, Date and Place of Birth
Fifth of September 1987 (Eighty Seven)
General Hospital, Kalutara
2. Name Marlon Trevin
3. Sex Male
Full Name ‘Samarappuli Chandra Siripala Fernando
Date of Birth Seventeenth of May 1947
4 Father's < Place of Birth Denipitiya
Race ‘Sinhalese
Rank or Profession Teaching
Full Name Jayasekara Gajahin Gamage Ramani Kanthi
Date of Birth ‘Twenty Fifth of June 1956
5.Mother’s Place of Birth Pathegama_
Race Sinhalese
‘Age ‘Thirty One Years
6. Were Parents Married ‘Yes
his full Name Samarappuli Coraneris Fernando
7.1 Grand father
‘Bom in Sri Lanka his year of birth 1916
his place of birth Kalutara
vows
2.03
4 2 OMe
nia 5358 38,
ani8. Ifthe father was notbom in [his full Name
Sri Lanka and if great year of birth
Father bor in SriLanka, | place of birth
the grand father
Father
was
bor in Ceylon
9. Informant's full name residence and
Jn what capacity he gives information
‘Samarappuli Chandra Siripala Femando
Panwila
Kalutara (Father)
10, Informant’s Signature
‘Signature illegible
11, Date of Registration
12. Registrar's Signature
13. Name inserted or substituted
after registration
14. Name of person on whom
Information particular relating
to item 13 were supplied and in
‘what capacity to information
‘Ninth of November 1987 (Eighty Seven)
Sed. MH.Senaramne
15. Date of insertion or substitution
and District Registrar or Registrar
General's Signature
1 do hereby certify that the foregoing is a true copy
ofa birth registration entry filed of record in this office
District Registrar Section
Divisional Secretariat
Kalutara Sgd. legible
Date: 07-11-2005 Additional District Registrar
Seal
PDS. Ranjanic
Photocopied by: Sed. Ilegibly Additional District Registrar
Compared by: Sgd. Ilegibly Kalutara
Itis hereby certified that the foregoing is a true and accurate English Translation of the Birth
Certificate No. 6455 issued in Sinhala
Date: 26" August 2014
Qn f
Swom Translator
8.
$. Sc. ENG. 8. LJ.P.
“INDO TADDUWA.
orsansisn ose agge4ss
Disraior cour.