0221-0811276623

(Issued under section 17 of the Reg istration of Death Act, 1969 and 8/13 of Delhi Reg istration of
Death Rule,1999)

This is to certify that the following information has been taken from the orig inal record of DEATH
which is the reg ister for North Delhi Municipal Corporation of CITY S.P. ZONE of N.C.T. Delhi

न ा म / Name SHIV KUMAR

लं ग / Gender MALE

म ृ यु क ित थ / Date Of Death 13-02-2021

म ृ यु का था न / Place Of Death B-1614 SHASTRI NAGAR SHASTRI NAGAR NORTH WEST DELHI INDIA
110052

पं ज ी करण क ित थ / Date Of Reg istration 28-12-2021

पं ज ी करण सं य ा / Reg istration No MCDOLIR-0221-0811152168

म ा ता का न ा म / Name of Mother DHARMWATI

िप ता /प ित का न ा म / Name of Father/Husband JAI RAM SINGH

ज ी वन सा थी का न ा म / Name of Spouse PRAVESH TOMER

वतम ा न प ता / Present Address B-1614 SHASTRI NAGAR NORTH WEST DELHI INDIA 110052

था ई प ता / Permanent Address B-1614 SHASTRI NAGAR NORTH WEST DELHI INDIA 110052

छप ा ई क ित थ / Print Date 28-12-2021

Note: This certificate is system g enerated and does not require any seal/sig nature in orig inal . The authenticity of
this certificate can be verified at mcdonline.nic.in
ये क ज म एवं म ृ यु का पं ज ी करण सुि न ि त करे
ENSURE REGISTRATION OF EVERY BIRTH & DEATH