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GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH AND FAMILY WELFARE
NARSINGPUR MINI 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 NARSINGPUR MINI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/
UNION TERRITORY ASSAM INDIA.

NAME OF DECEASED : AJIB UDDIN BARBHUIYA SEX: MALE

DATE OF DEATH PLACE OF DEATH:

17-05-2023 BANSKHAL (BARJALENGA PT VI) JOGIABASTI, NARSINGPUR PT I,
SONAI ,CACHAR, ASSAM ,
SEVENTEEN MAY TWO THOUSAND
TWENTY THREE
NAME OF HUSBAND / WIFE:
REKSANA BEGUM
AGE OF DECEASED:
51 YEARS
HUSBAND /WIFE AADHAR NO:

NAME OF MOTHER: NAME OF FATHER:

RAICH ALI BARBHUIYA

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

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

BANSKHAL (BARJALENGA PT VI), JOGIABASTI, , BANSKHAL (BARJALENGA PT VI), JOGIABASTI, ,

SILCHAR,CACHAR, ASSAM , SILCHAR ,CACHAR, ASSAM

REGISTRATION NO: DATE OF REGISRTAION:

D:2023: 18-00711-000161 18-08-2023

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY

18-08-2023
REGISTRAR (BIRTH & DEATH)
NARSINGPUR MINI PRIMARY HEALTH CENTRE
UPDATED ON:
18-08-2023 12:06:15

“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”