EETole 2173 Death

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FROM-6

GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH SERVICES
HARINA NEW PRIMARY HEALTH CENTRE

DEATH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969AND RULE 8/13 OF THE ASSAM
REGISTRATION OF BIRTHS 7 DEATHS RULES 1999)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH
IS THE REGISTER FOR SONAI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION
TERRITORY ASSAM INDIA.

NAME OF DECEASED : MUKTAR UDDIN LASKAR SEX: MALE

DATE OF DEATH PLACE OF DEATH:


12-02-2022 NEAIRGRAM PT II P.O NEAIRGRAM
TWELVE FEBRUARY TWO THOUSAND TWENTY TWO CACHAR, ASSAM - 788013

AGE OF DECEASED: NAME OF HUSBAND/WIFE:


40 YEARS
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:
SAIFUL ALI LASKAR
MOTHER’S AADHAR NO: FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:
NEAIRGRAM PT II P.O NEAIRGRAM NEAIRGRAM PT II P.O NEAIRGRAM
CACHAR, ASSAM - 788013 CACHAR, ASSAM - 788013

REGISTRATION NO: DATE OF REGISRTAION:


D:2022 18-12394-556229 07-09-2022

REMARKS (IF ANY):


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DATE OF ISSUE: ISSUING AUTHORITY

20-10-2022 REGISTRAR (BIRTH & DEATH)


SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
20-10-2022 11:26:55

“THIS IS A COMPUTER GENERATED CERTIFICATE”


THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27 JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES.
“ENSURE REGISTRATION OF EVERY BIRTH AND DEATH”

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