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    of 1

    सं.

    1
    No. 1 मय देश सरकार प-6
    GOVERNMENT OF MADHYA PRADESH FORM-6
    योजना, आिथक एवं सांियक वभाग
    DEPARTMENT OF PLANNING, ECONOMICS & STATISTICS
    नगर पंचायत बड़ा गांव
    NAGAR PANCHAYAT BADAGAON

    मृयु माण-प
    DEATH CERTIFICATE

    (जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा मय देश जम मृयु रिजकरण नयम, 1999 के नयम 8/13 के अंतगत जार कया गया )

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

    यह मािणत कया जाता है ननलिखत सुचना मृयु के मूल अभलेख से ल गई है जो क नगर पंचायत बड़ा गांव तहसील टकमगढ़ िजला टकमगढ़ राय/संघ देश मय
    देश,भारत के रिजटर म उिलिखत है ।
    THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR NAGAR
    PANCHAYAT BADAGAON OF TAHSIL/BLOCK TIKAMGARH OF DISTRICT TIKAMGARH OF STATE/UNION TERRITORY MADHYA PRADESH, INDIA.

    मृतक का नाम / NAME OF DECEASED : BARE LAL AHIRWAR लंग / SEX: पुरष / MALE

    आधार नंबर / AADHAAR NO.:


    XXXXXXXX4834

    मृयु क तथ / DATE OF DEATH: मृयु का थान / PLACE OF DEATH:


    28-06-2018 BADAGAON (DHASAN), WARD NO. 07, BADAGAON (DHASAN), BADAGAON
    TWENTY-EIGHTH-JUNE-TWO THOUSAND EIGHTEEN (NP), TIKAMGARH, TIKAMGARH, MADHYA PRADESH, 472010.

    पत / पी का नाम / NAME OF HUSBAND / WIFE:


    मृतक क उ / AGE OF DECEASED: BATEE AHIRWAR
    44 YEARS
    आधार नंबर / HUSBAND/WIFE AADHAAR NO. :
    XXXXXXXX6254

    माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER :


    MIRCHA AHIRWAR

    आधार नंबर / MOTHER'S AADHAAR NO. : आधार नंबर / FATHER'S AADHAAR NO. :

    मृयु के समय मृतक का पता / ADDRESS OF THE DECEASED AT THE TIME OF DEATH : मृतक का थायी पता / PERMANENT ADDRESS OF DECEASED :

    BADAGAON (DHASAN), WARD NO. 07, BADAGAON (DHASAN), WARD NO. 07,
    BADAGAON (DHASAN), BADAGAON (NP), TIKAMGARH, TIKAMGARH, BADAGAON (DHASAN), BADAGAON (NP), TIKAMGARH, TIKAMGARH,
    MADHYA PRADESH- 472010 MADHYA PRADESH- 472010

    पंजीकरण संया / REGISTRATION NO: पंजीकरण तारख / DATE OF REGISTRATION:


    D-2018: 23-90053-000023 02-07-2018

    टपणी / REMARKS (IF ANY):


    OK

    जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
    03-07-2018
    रिजार (जम एवं मृयु)
    REGISTRAR (BIRTH & DEATH)
    नगर पंचायत बड़ा गांव
    NAGAR PANCHAYAT BADAGAON

    UPDATED ON :
    02-07-2018 15:45:45

    "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 DOUCMENT FOR ALL OFFICIAL PURPOSES.
    " येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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