FROM-6

GOVERNMENT OF ASSAM

DEPARTMENT OF HEALTH AND FAMILY WELFARE

SONABARIGHAT SUBSIDIARY 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 SONABARIGHAT SUBSIDIARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/
UNION TERRITORY ASSAM INDIA.

NAME OF DECEASED : KUKILA BEGUM SEX: FEMALE

AADHAAR NO. :
XXXXXXXX5944
PLACE OF DEATH:
DATE OF DEATH
26-06-2023 SILDUBI GRANT PART - I, SILCHAR,
TWENTYSIX JUN TWO THOUSAND CACHAR, ASSAM - 788112
TWENTY THREE

AGE OF DECEASED: NAME OF HUSBAND/WIFE:

MOHIB UDDIN
42 YEARS
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:

MOTHER’S AADHAR NO: FATHER’S AADHAR NO:

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

SILDUBI GRANT PART - I, SILCHAR, SILDUBI GRANT PART - I, SILCHAR,

CACHAR, ASSAM - 788112 CACHAR, ASSAM - 788112

REGISTRATION NO: DATE OF REGISRTAION:

D:2023 18-12894-001040 21-08-2023

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY
21-08-2023 REGISTRAR (BIRTH & DEATH)

SONABARIGHAT SUBSIDIARY HEALTH CENTRE

UPDATED ON:
21-08-2023 02:06:15

“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”