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 --------------  

  

  

                                                                                       Signature of Issuing authority

Date                                                              Seal

  

                                                                                               

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

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