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 & 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 : ISMAIL ALI TALUKDAR SEX: MALE

DATE OF DEATH PLACE OF DEATH:

03-04-2023 PAIKAN PO- GUMRA BAZAR, CACHAR, ASSAM
THREE APR TWO THOUSAND
TWENTY THREE NAME OF HUSBAND/WIFE:

AGE OF DECEASED: HUSBAND /WIFE AADHAR NO:

38 YEARS
NAME OF MOTHER: NAME OF FATHER:
ABDUL MANNAN TALUKDAR
MOTHER’S AADHAR NO: FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:

PAIKAN PO- GUMRA BAZAR CACHAR, PAIKAN PO- GUMRA BAZAR CACHAR,
ASSAM, CACHAR, ASSAM,

REGISTRATION NO: DATE OF REGISRTAION:

D:202 18-12394-551544 01-05-2023

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY
05-05-2023 REGISTRAR (BIRTH & DEATH)
KATIGORAH PRIMARY HEALTH CENTRE
UPDATED ON:
05-05-2023 02:26:20

“THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY”
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”