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APPLICATION FOR NON AVAILABILITY CERTIFICATE FOR DEATH


From To

Name: The Registrar of Birth and Deaths,

Address: Registration Unit ID._______________________,


._______________________,

Telephone No: District Name _____________________________,

CDMA Department,

Sir,

Sub: - Request of Non-availability


availability for Death Certificate –Reg.

><<>><

I,______________________________
I,___________________________________S/o./W/o._________________________________
__________________________

Aged about _____________ years working as ______


________________________________________
________________
_________________________________________________
__________________________ (Designation & office Address)
Residing at H.No __________________
________________________________________________________________
____________________
__________________________________________________
__________________________________________________ (Complete
Complete door No & Address).

I declare that My_______________


My________________________________________________
_________________________________ (Relation & Name)
died at ______________________
________________________________________________
_____ (Place of Death)
because of ___________________________ (Cause of Death) on___________
_ (Date
( of Death).

 I hereby declare that the above


above-mentioned
mentioned information is correct up to my knowledge and
I bear the responsibility for the correctness of the above
above-mentioned.

Documents to be enclosed: Signature of the Applicant

1. Application Form

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