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    Death Certificate

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    shyambharada1432

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    © All Rights Reserved
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    Death Certificate

    Uploaded by

    shyambharada1432
    6 views2 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

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    6 views2 pages

    Death Certificate

    Uploaded by

    shyambharada1432

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    snu-e FORM-6

    GOVERNMENT OF GUJARAT

    DEPARTMENT OF HEALTH AND FAMILY


    WELFARETDA 0539935

    DEATH CERTIFICATE
    (lssued under Section 12/17 ofthe Registration ofBirths and Deaths Act, 1969 and Rule 8 of the Cujarat Registration of Birhs and Deaths Rules, 2018)

    .61.dlA.,a. (au«) 1oc - 14,00,000-10-2020


    61 - FORM -6

    GOVERNMENT OF GUJARAT

    DEPARTMENT OF HEALTH AND FAMILY WELFARE

    DEATH CERTIFICATE
    i d - H 2 t kell GHaAi, 200rL Aua - c/13 j7u)
    (Issued under Section 12/17 of the Registration of Births and Deaths Act, 1969
    and Rule 8/13 of the Gujarat Registration of Births and Deaths
    Rules, 2004)
    L******'*********
    *****.

    **14/28211 2P*2ai 3.
    This is to Certify that the following information has been taken from the original record of death which is in the
    register for Village/City.
    ....s . Of laluka . . of District.. ...of Gujarat State.
    . . ala (y/il):*
    '**''*"*****°*'
    * *°*°° *****e***

    1 Name L. Sex (M/F)) ******** *********

    3. .

    3. Date of Death 4. Place of Death:


    :'***''*******'' ****°*******
    ***
    U u / u a 1 H : "**************''**** '*****°**°**
    s.
    5. Name of Mother 6.
    Name of Father/Husband: *** ****************

    7. Address of deceased at the time of Death. 8. Permanent address of deceased


    **'** **°° ***°

    * * * *

    C. 10. 9l-1 dllu: *****

    9. Registration No. 10. Date of Registration:*


    11. Hsa (aav ü«):
    11. Remarks (ifany) **

    Signature ofthe issuing authority..


    .*** .***.****************************************

    Date of issue .

    *******a.******.*** ************°*****"***************

    ***"****"*****"******°****"****************°** °******

    ( Seal Address of the issuing authorityy


    Ensure Registration of every Birth & Death

    .L.-(a14)-117-10,00,0oo-10-2014.(1)

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