iz:i la[;k&6
Form-6
laΠ324524
No. lR;eso t;rs
fcgkj ljdkj
Government of Bihar
;kstuk ,oa fodkl foHkkx
fcgkj ljdkj (DEPARTMENT OF PLANNING AND DEVELOPMENT)
vFkZ ,oa lkaf[;dh funs'kky;
DIRECTORATE OF ECONOMICS AND STATISTICS
e`R;q izek.k&i=
DEATH CERTIFICATE
¼tUe e`R;q jftLVªhdj.k vf/kfu;e] 1969 dh /kkjk&12@17 rFkk fcgkj tUe e`R;q jftLVªhdj.k
fu;ekoyh] 1999 ds fu;e 8@13 ds vUrxZr tkjh fd;k x;kA½
(Issued under Section-12/17 of the registration of Births and Deaths Act, 1969 and Rule 8/13 of the Bihar
Registration of Births and Deaths Rules, 1999)
;g izekf.kr fd;k tkrk gS fd fuEufyf[kr lwpuk e`R;q ds ewy vfHkys[k ls yh xbZ gS] tks fd
¼LFkkuh; {ks=½-----------------------------------rglhy¼vapy@iz[kaM½-----------------------------------------------
ftyk --------------------------------------------- jkT;% fcgkj ds jftLVj esa mfYyf[kr gSA
This is to Certify that the following information has been taken from the original record of death which is the
register for (local area/local body) ......................................................... of tahsil.............................................
.(anchal/block)...................................................... of District ............................................ of State : Bihar
uke@Name........................................................................................................... fyax@ Sex.........................................
e`R;q dh frfFk@ Date of Death......................................... e`R;q dk LFkku@Place of Death ..............................
ekrk dk uke@Name of Mother............................................................................
firk@ifr dk uke@Name of Father/Husband...............................................
e`rd dk e`R;q ds le; dk irk@ e`rd dk LFkk;h irk@
Address of the deceased at the time of death Permanent address of the deceased
............................................................................ ......................................................................................
........................................................................... ......................................................................................
............................................................................ ......................................................................................
iathdj.k la[;k@ Registration No....................................... iathdj.k fnukad@Date of Registration ...........................
fVIi.kh@ Remarks(if any)......................................................
tkjh djus dh frfFk@Date of issue....................................
izkf/kdkjh ds gLrk{kj@ Signature of the Issuing authority
izkf/kdkjh dk irk@ Address of the Issuing authority
eksgj@Seal
0379 Raju 28.12.10
^^ izR;sd tUe ,oa e`R;q dk iathdj.k lqfuf'pr djsa@Ensure registration of every birth and death**
0379 Raju 28.12.10
