FROM-6
GOVERNMENT OF ASSAM
                                       DEPARTMENT OF HEALTH SERVICES
                                         SONAI 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 & 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 : JAHANARA BEGUM LASKAR                     SEX: FEMALE
DATE OF DEATH                                                PLACE OF DEATH:
08-04-2023                                                   SONAI MUKH, TULARGRAM PART - II, SONAI,
EIGHT APR TWO THOUSAND                                       CACHAR, ASSAM - 788119
TWENTY THREE
AGE OF DECEASED:                                             NAME OF HUSBAND/WIFE:
29 YEARS
                                                             HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER:                                              NAME OF FATHER:
                                                             FOZAL MIA LASKAR
MOTHER’S AADHAR NO:                                          FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH                 PERMANENT ADDRESS OF DECEASED:
SONAI MUKH, TULARGRAM PART - II, SONAI,                      SONAI MUKH, TULARGRAM PART - II, SONAI,
CACHAR, ASSAM - 788119                                       CACHAR, ASSAM - 788119
REGISTRATION NO:                                             DATE OF REGISRTAION:
D:2023   18-12394-001244                                     18-07-2023
REMARKS (IF ANY):
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DATE OF ISSUE:                                                ISSUING AUTHORITY
18-07-2023                                                            REGISTRAR (BIRTH & DEATH)
                                                                  SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
18-07-2023   01:26:15
                                    “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”