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    Name of Local Body Issuing Certificate

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    Muhammad Raad
    This document is a death certificate from the government of India. It provides details of the deceased such as name, UID number, sex, date and place of death, names and UID numbers of parents and spouse. It also lists the addresses of the deceased at the time of death and permanent address. It includes the registration number and date of registration.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Name of Local Body Issuing Certificate

    Uploaded by

    Muhammad Raad
    125 views1 page
    This document is a death certificate from the government of India. It provides details of the deceased such as name, UID number, sex, date and place of death, names and UID numbers of parents and spouse. It also lists the addresses of the deceased at the time of death and permanent address. It includes the registration number and date of registration.

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    death certificate

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    This document is a death certificate from the government of India. It provides details of the deceased such as name, UID number, sex, date and place of death, names and UID numbers of parents and spouse. It also lists the addresses of the deceased at the time of death and permanent address. It includes the registration number and date of registration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    125 views1 page

    Name of Local Body Issuing Certificate

    Uploaded by

    Muhammad Raad
    This document is a death certificate from the government of India. It provides details of the deceased such as name, UID number, sex, date and place of death, names and UID numbers of parents and spouse. It also lists the addresses of the deceased at the time of death and permanent address. It includes the registration number and date of registration.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ÑßÑðëð– 6

    Form-6
    çðü.No.
    ………….. çðܨîðÜ
    GOVERNMENT OF....................
    State
    Govt. .......................òãðØðð±ð/.......................................
    Emblem (ÑßÙððÂð Ñðëð ¸ððÜó ¨îÜÐð÷ ãððâð÷ çÆððÐðóÚð òÐð¨îðÚð ¨îðÐððÙð)
    DEPARTMENT OF...................../..............................
    (Name of local body issuing certificate)

    ÙðöÃÚðô ÑßÙððÂð Ñðëð


    DEATH CERTIFICATE
    (¸ðÐÙð ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð ¡òÏðòÐðÚðÙð, 1969 ¨îóÏððÜð 12/17 ÃðÆðð.............................¸ðÐÙð ÙðöÃÚðô Üò¸ðç¾àó¨îÜÂð òÐðÚðÙð,
    (Üð¸Úð ¨îð ÐððÙð)
    ..................................................¨÷î òÐðÚðÙð 8/13 ¨÷î ¡üÃð±ðáÃð ¸ððÜó ò¨îÚðð ±ðÚðð)
    (çðüäðð÷òÏðÃð òÐðÚðÙð ¨îð÷ ¡òÏðçðõòµðÃð ò¨î¦ ¸ððÐð÷ ¨îð ãðæðá)
    (Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969 and Rule 8/13 of
    the ........................ Registration of Births and Deaths
    Rules............................................................................. (Name of State)
    (Year of notifying the revised rules)
    Úðè ÑßÙððòÂðÃð ò¨îÚðð ¸ððÃðð èø òÐðÙÐðòâðò®ðÃð çðõµðÐðð ÙðöÃÚðô ¨÷î Ùðõâð âð÷®ð çð÷ âðó ±ðýá èø ¸ðð÷ ò¨î (çÆððÐðóÚð êð÷ëð)
    ................................................................................ Ãðèçðóâð
    ............................................................................... ò¸ðâðð
    .......................................................................Üð¸Úð ..................................... ¨÷î Üò¸ðç¾Ü Ùð÷ü £òââðò®ðÃð èø
    This is to certify that the following information has been taken from the original record of death
    which is the register for (local area/local body) ...........................................................of tahsil /block
    ........................of District .................................... of State/Union territory .......................................

    ÐððÙð/Name: ..................................................................................
    ÙðöÃð¨î का यूआईडी न॰/UID No of deceased………………………………….
    òâðü±ð/Sex.........................................................................................
    ÙðöÃÚðô ¨îó òÃðòÆð/Date of Death............................................................
    ÙðöÃÚðô ¨îð çÆððÐð/Place of Death............................................................
    ÙððÃðð ¨îð ÐððÙð/Name of Mother..........................................................
    माता का यूआईडी न॰/UID No of Mother…………………………………………….
    òÑðÃðð ¨îðÐððÙð/Name of Father……………………………………..…..…..
    पिता का यूआईडी न॰/UID No of Father…………………….…………………………….
    िपत/ित्नी का नाम/Name of Husband / Wife……………….………..…...…
    िपत/ित्नी का यूआईडी न॰/UID No of Husband / Wife……………………….
    ÙðöÃð¨î ¨îð ÙðöÃÚðô ¨÷î çðÙðÚð ¨îð ÑðÃðð ÙðöÃð¨î ¨îð çÆððÚðó ÑðÃðð/
    Address of the deceased at the time of death: Permanent address of the deceased:
    ...........................................................
    ............................................................ ...........................................................
    ............................................................
    ……………………………………..
    Ñðü¸ðó¨îÜÂðçðü®Úðð/Registration No :.............Ñðü¸ðó¨îÜÂð òÇÐððû¨î/Date of Registration................
    ò¾ÑÑðÂðó/Remarks (if any).........................
    ¸ððÜó ¨îÜÐð÷ ¨îó òÃðòÆð/Date of issue:......ÑßðòÏð¨îðÜó ¨÷î èçÃððêðÜ/Signature of the issuing authority
    ÑßðòÏð¨îðÜó ¨îð ÑðÃðð/ Address of the issuing authority
    Ùðð÷èÜ/Seal
    ÑßÃÚð÷¨î ¸ðÐÙð ¦ãðÙð þÙðöÃÚðô ¨îð Ñðü¸ðó¨îÜÂð çðôòÐðòäµðÃð ¨îÜ÷ü/ “Ensure registration of every birth and death

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