Form-6

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

GRAM PANCHAYAT GUMA-II

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 GRAM PANCHAYAT GUMA-II OF BLOCK/MUNICIPALITY HABRA - II OF DISTRICT NORTH 24 PARGANAS OF
STATE WEST BENGAL, INDIA.

NAME OF DECEASED : NITAI GHOSH SEX : MALE

DATE OF DEATH : 08/07/2022 PLACE OF DEATH : TAJPUR GHOSH PARA,HABRA - II,

NORTH 24 PARGANAS, GUMA-II, TAJPUR,
WEST BENGAL - 743704

AGE OF DECEASED : 45 YEARS NAME OF SPOUSE : NUPUR GHOSH

SPOUSE IDENTITY PROOF. : AADHAAR-

384901789427

NAME OF MOTHER : LATE SHANTI LATA NAME OF FATHER : LATE LAKSHAN GHOSH
GHOSH

MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -

ADDRESS OF THE DECEASED AT BLDG.NO & NAME:- TAJPUR GHOSH PARA,LOCALITY:-PO - GUMA, VILLAGE/TOWN:-
THE TIME OF DEATH : TAJPUR,HABRA - II,DIST:- NORTH 24 PARGANAS,WEST BENGAL-743704

PERMANENT ADDRESS OF BLDG.NO & NAME:- TAJPUR GHOSH PARA,LOCALITY:-PO - GUMA, VILLAGE/TOWN:- TAJPUR,
DECEASED : HABRA - II,DIST:- NORTH 24 PARGANAS,WEST BENGAL-743704

CERTIFICATE NO : D/2022/085455 DATE OF REGISTRATION : 14/07/2022

REMARKS (IF ANY) :

DATE OF ISSUE : 14/07/2022 ISSUING AUTHORITY :

UPDATED ON : 2022-07-14 13:10:37

Signature Not Verified

Digitally Signed.
Name: JESMIN GAZI
Date: 14-Jul-2022 14:41:00

SUB-REGISTRAR (BIRTH & DEATH)

GRAM PANCHAYAT GUMA-II

"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 DOUCMENT FOR ALL OFFICIAL PURPOSES

"ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "