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 : ALAJUN BEGUM LASKAR SEX: FEMALE
DATE OF DEATH PLACE OF DEATH:
04-01-2023 DHANIPUR P.O. SONAIMUKH
FOURTH JAN TWO THOUSAND CACHAR, ASSAM - 788119
TWENTY THREE
AGE OF DECEASED: NAME OF HUSBAND/WIFE:
48 YEARS AMIR UDDIN LASKAR
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:
MOTHER’S AADHAR NO: FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:
DHANIPUR P.O. SONAIMUKH DHANIPUR P.O. SONAIMUKH
CACHAR, ASSAM - 788119 CACHAR, ASSAM - 788119
REGISTRATION NO: DATE OF REGISRTAION:
D:2023 18-12394-551777 20-02-2023
REMARKS (IF ANY):
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DATE OF ISSUE: ISSUING AUTHORITY
10-03-2023 REGISTRAR (BIRTH & DEATH)
SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
10-03-2023 11:16:00
“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”