Ministry of Interior Affairs

Department of Assessment of Affairs of Foreigners &

Registration of Status of Citizens

Statistics Department: Province: XXXXX

Bureau: District: XXXXX
Office: Village: XXXXX
Volume: XXXXX Page XXXXX
Number XXXXX Date XXXXX

Details of Death Report

Particulars of the Deceased
Name: XXXXX Province:
Father’s name: XXXXX District:
Grand Father name: XXXXX Village/Area: XXXXX
Volume: XX, Page:
Age: National ID No.
XX, Reg: XX
Marital Status: Married Family number: XX people
Nationality: Afghan Occupation: XXXXX

Particulars of Death:
Date of death: XXXXX Report date: XXXXX
Registration date: XXXXX Cause of death: XXXXX
Place of death: Type of disease:

In Case of The Lack of National ID of the Deceased, Identity of its Next of Kin
Name: Province:
Father’s name: District:
Grand Father name: Village/Area:
National ID No.

Particulars of the Reporter:

Name: XXXXX Province: XXXXX
Father’s name: XXXXX District: XXXXX
Grand Father name: XXXXX Village/Area:
Volume: XX, Page:
National ID No. Relationship:
XX, Reg: XX

Particulars of the Registration Officer

Name: XXXXX Position:
Signature & Stamp Date: