Form-6

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

DISTRICT HOSPITAL NADIA

DEATH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR DISTRICT HOSPITAL NADIA OF BLOCK/MUNICIPALITY MUNICIPALITY KRISHNAGAR OF DISTRICT NADIA OF
STATE WEST BENGAL, INDIA.

NAME OF DECEASED : SHANKAR SEX : MALE

BHATTACHARYYA

DATE OF DEATH : 24/01/2024 PLACE OF DEATH : DISTRICT HOSPITAL NADIA,

MUNICIPALITY KRISHNAGAR, NADIA,
WEST BENGAL

AGE OF DECEASED : 79 YEARS NAME OF SPOUSE :

SPOUSE IDENTITY PROOF. : -

NAME OF MOTHER : NAME OF FATHER : LT NIRAPADA BHATTACHARYYA

MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -

ADDRESS OF THE DECEASED AT STREET/LANE:- GHOSH PARA,LOCALITY:-DURGAPUR, VILLAGE/TOWN:-

THE TIME OF DEATH : DURGAPUR,KRISHNAGANJ,DIST:- NADIA,WEST BENGAL-741506

PERMANENT ADDRESS OF STREET/LANE:-GHOSH PARA,LOCALITY:-DURGAPUR, VILLAGE/TOWN:- DURGAPUR,

DECEASED : KRISHNAGANJ,DIST:- NADIA,WEST BENGAL-741506

CERTIFICATE NO : D/2024/0108451 DATE OF REGISTRATION : 16/02/2024

-

REMARKS (IF ANY) :

DATE OF ISSUE : 16/02/2024 ISSUING AUTHORITY :

UPDATED ON : 2024-02-11 13:24:08

Signature Not Verified

Digitally Signed.
Name: GOLAK MONDAL
Date: 16-Feb-2024 15:43:36

REGISTRAR (BIRTH & DEATH)

DISTRICT HOSPITAL NADIA

"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"