Form-6
GOVERNMENT OF WEST BENGAL
DEPARTMENT OF HEALTH AND FAMILY WELFARE
MUNICIPAL CORPORATION DURGAPUR
DEATH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR MUNICIPAL CORPORATION DURGAPUR OF BLOCK/MUNICIPALITY MUNICIPAL CORPORATION DURGAPUR OF
DISTRICT PASCHIM BARDHAMAN OF STATE WEST BENGAL, INDIA.
NAME OF DECEASED : SUNDAR GOPAL SEX : MALE
GHATAK
DATE OF DEATH : 15/10/2022 PLACE OF DEATH : VIVEKANANDA HOSPITAL, MUNICIPAL
CORPORATION DURGAPUR, PASCHIM
BARDHAMAN, WEST BENGAL
AGE OF DECEASED : 87 YEARS NAME OF SPOUSE :
SPOUSE IDENTITY PROOF. : -
NAME OF MOTHER : NAME OF FATHER : LATE NARENDRA NATH GHATAK
MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -
ADDRESS OF THE DECEASED AT STREET/LANE:- BANDRA, KATWA,LOCALITY:-KATWA, VILLAGE/TOWN:- BANDRA,KATWA - I,DIST:-
THE TIME OF DEATH : PURBA BARDHAMAN,WEST BENGAL-713130
PERMANENT ADDRESS OF STREET/LANE:-BANDRA, KATWA,LOCALITY:-KATWA, VILLAGE/TOWN:- BANDRA, KATWA - I,DIST:-
DECEASED : PURBA BARDHAMAN,WEST BENGAL-713130
CERTIFICATE NO : D/2022/241982 DATE OF REGISTRATION : 20/10/2022
REMARKS (IF ANY) :
DATE OF ISSUE : 21/10/2022 ISSUING AUTHORITY :
UPDATED ON : 2022-10-20 12:24:40
Signature Not Verified
Digitally Signed.
Name: DEBABRATA SAHANA
Date: 21-Oct-2022 11:37:14
REGISTRAR (BIRTH & DEATH)
MUNICIPAL CORPORATION DURGAPUR
"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 "
