Meeseva CDMA APPLICATION FOR DEATH CERTIFICATE

Meeseva CDMA APPLICATION FOR DEATH CERTIFICATE

Download Meeseva CDMA APPLICATION FOR DEATH CERTIFICATE

APPLICATION FOR DEATH CERTIFICATE
(Write in Capital Letters)
CIRCLE / LOCALITY :
1. Date Of Death :
2. Name of the Deceased :
3. Sex of the Deceased :
4. Name of the Father of the deceased :
5. Name of the Mother :
6. Place of Death :
(
Tick the appropriate entry a, b, c below and give t
he name of the Hospital/Institute or the
Address of the House where the Death took place. If
other place give location)
a) Hospital/Institution Name :
b) House Address :
c) Other place :
7.No.of Copies Required :
8 a) Do you want the Death Certificate by Courier-
Yes / No.
b) If Yes give Name and Address with Pin Code
Name & address. (Signature of the Applicant)
Telephone No:
Note:- Death certificate will be issued subject to
entry found Registered with
in DEATH
RECORDS-C&DMA/PANCHYATS