The land of the Dancing Deer

 

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FORM NO. 6
(See Rule 8)

DEATH CERTIFICATE
(Issued under Section 12/17)

 

 

This is to certify that the following information has been taken from the original record of death which is the register for (Local Area) ... ...of Tahsil of District .. of State ..

Name ..
Sex ..
Date of Death ...
Place of Death ..
Registration No. ...
Date of Registration ..



Date ..                                                                           Signature of Issuing Authority
                                                                                                                                  Seal



__________________________________________________________________________________

No disclosure shall be made of particulars regarding the cause of death as entered in the Register. See proviso to Section 17(1)


D/P&S -- No. 811/28-4-2000 Medical 20,000 C/15-5-2000.