FROM-6

GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH SERVICES
HARINA NEW PRIMARY HEALTH CENTRE

DEATH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969AND RULE 8/13 OF THE ASSAM
REGISTRATION OF BIRTHS 7 DEATHS RULES 1999)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR SONAI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION
TERRITORY ASSAM INDIA.

NAME OF DECEASED : SHARBONI DAS SEX: FEMALE

DATE OF DEATH PLACE OF DEATH:

18-08-2022 CHANNIGHAT, P.S DHOLAI
EIGHTEEN AUGUST TWO THOUSAND TWENTY TWO CACHAR, ASSAM - 788120

AGE OF DECEASED: NAME OF HUSBAND/WIFE:

23 YEARS
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:
KANAILAL DAS
MOTHER’S AADHAR NO: FATHER’S AADHAR NO:

ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:

CHANNIGHAT, P.S DHOLAI CHANNIGHAT, P.S DHOLAI

CACHAR, ASSAM - 788120 CACHAR, ASSAM - 788120

REGISTRATION NO: DATE OF REGISRTAION:

D:2022 18-12394-556229 07-09-2022

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY
20-11-2022 REGISTRAR (BIRTH & DEATH)
SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
20-11-2022 11:26:55

“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”