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    Death Reg Form Kenya

    Uploaded by

    Olive Computers
    This document appears to be a death certificate form used by medical practitioners and hospitals. It contains fields to record information about the deceased such as name, date and place of death, age, occupation, cause of death as determined by a medical practitioner, and signatures of the local registrar. The form instructs that it must be completed in duplicate to obtain a burial or cremation permit and specifies where to take the completed forms.

    Copyright:

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

    Death Reg Form Kenya

    Uploaded by

    Olive Computers
    49 views1 page
    This document appears to be a death certificate form used by medical practitioners and hospitals. It contains fields to record information about the deceased such as name, date and place of death, age, occupation, cause of death as determined by a medical practitioner, and signatures of the local registrar. The form instructs that it must be completed in duplicate to obtain a burial or cremation permit and specifies where to take the completed forms.

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    death reg form Kenya

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    death reg form Kenya

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    This document appears to be a death certificate form used by medical practitioners and hospitals. It contains fields to record information about the deceased such as name, date and place of death, age, occupation, cause of death as determined by a medical practitioner, and signatures of the local registrar. The form instructs that it must be completed in duplicate to obtain a burial or cremation permit and specifies where to take the completed forms.

    Copyright:

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

    Death Reg Form Kenya

    Uploaded by

    Olive Computers
    This document appears to be a death certificate form used by medical practitioners and hospitals. It contains fields to record information about the deceased such as name, date and place of death, age, occupation, cause of death as determined by a medical practitioner, and signatures of the local registrar. The form instructs that it must be completed in duplicate to obtain a burial or cremation permit and specifies where to take the completed forms.

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    FORM A2

    DUPLICATE REGISTER OF DEATH


    (For use by Medical Practitioners and in hospitals)
    District: Registrar's Serial No.:

    1. Full Baptismal or Middle or Tribal Surname or Tribal Name of


    Name given Name(s) Name Father
    of Son or
    IMPORTANT– A record must be made for each death. Use a typewriter or ball-point pen or other pen with black or dark blue ink.

    Deceased daughter of

    2. Date Date of Month: Month: Year: 3.Sex of Deceased


    Of Male .. .. 1
    Death Female .. .. 2

    4. Age Years( If under one year state in 5. Occupation of Deceased


    Of months……………………………………………...
    Deceased or days………………………………………………)

    Code 6 Exact No. of house and street Name of town, if If in Institution, name of hospital or
    Place Or road, if any any, or Village/Sub- medical centre
    Of location and location
    Death

    7. Normal If Deceased not normally resident at above place, state District in which he lived.
    Residence
    This is a permanent legal record. Be sure to use the carbon copy is legible.

    Code of
    Deceased

    8.TO BE COMPLETED BY MEDICAL PRACTITIONER: Interval between


    On set and Death
    A. Cause of Death– Enter one cause per line :

    I. IMMEDIATE CAUSE (A)………………………………………………………………………. ….


    Code DUE TO (B)…………………………………………………………………………...

    DUE TO (C ) …………………………………………………………………………
    .
    II.OTHER SIGNIFICANT CONDITIONS…………………………………………………………….

    B. Certificate
    I certify that-
    (a) I attended the deceased, or
    Delete as (b) I examined the body after death, or
    appropriate (c) I conducted a post mortem examination of the above information
    is correct to the best of my knowledge.

    Signature………………………… Title……………………... Date……………………………………..

    NAME IN BLOCK LETTERS ……………………………………………. ………………………………...

    9. Signature of Local Registrar……………………………. Date record received……. ………………...

    TO OBTAIN A DISPOSAL PERMIT (BURIAL OR CREMATION) THIS CERTIFICATE IN


    DUPLICATE (TWO FORMS) MUST BE TAKENT TO THE OFFICE OF THE REGISTRAR OF
    DEATHS AT:-
    On week-days (during office
    hours); or
    On Sundays and Public Holi-
    days and after office hours
    on week-days

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