8o.2..30..

No. B.B.M.P.
1220499 6
Form-6
Government of India

GOVERNMENT OF KARNATAKA

Chief Registrar of Births and Deaths

(%.0.ee eQIabo, 19698 12/17äo T5do i 8.%.D.iAe. obrieo 19998 obs 8/138 doedri dodeot)

DEATH CERTIFICATE
(Issued Under Section 12/17 of the RBD Act, 1969 and Rule 8/13 of the KRBD Rules, 1999)

ddbod sriabdoyoahdadbod aaacdesbieahd

This is to certify that the following information has been taken from the original record of death
which is the register for BBMP
(vilageltown) of Bengaluru district of Karnataka State
28on nod

Name ASHOK Sex Male

) abood Bveo5 12/12/2020
Date of Death
NGALORe
oRE
Place of Death

13 1ST MAIN4TH CROSS BANGARAPPA NAGAR|

R.R.NAGAR, BBMP, Bengaluru, Karnataka
5) 30aba Bvd 6) Bodab d d

Name of Mother PUTTAMMA Name of the Father LATE SHIVANNA

7 road/ #odSab sid

Name of the Husband/Wife

9 a a0 DavO dPT
9) abod Tabavd) ay3d s r

. o.8, , ioristod, 3rDFE38

0 . , , oridod), 3nort33

Address of deceased at the time of death: Permanent address of the deceased:

BANGARAPPA NAGAR 13, 1ST MAIN 4TH CROSS BANGARAPPA NAGAR

13, 1ST MAIN 4TH CROSS R.R.NAGAR, BBMP,Bengaluru,Karnataka
R.R.NAGAR, BBMP,Bengaluru,Karnataka
10) rdeeod #oa 803162/B/D/2020/077375 teeodf apocau 21/12/2020
Date of Registration:
Registration No.: eo
13) eRbaoediat 3vpo8 21/12/2020
12) op(arJoopd ng)
Remarks(if any) Date of Approval

Signature of Issuing Authority Address of the issuing authority Medical Officer

RAJARAJESHWARIEAGAR, Bengaluru District

B.B.M.P. iealth
Barngalore-98.
Date of Issue
a rN
i a
21/12/2020
esh

oo pTD Oe8oth bdred norene wr wodorRoebso8e. d5do 17(1)d ddoab8 dora.

Note:
For Online Verification please Visit: www.ejanma.kar.nic.in