सं.

1
No. 1
उर देश सरकार प-6
GOVERNMENT OF UTTAR PRADESH FORM-6
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
नगर नगम लखनऊ े 6
NAGAR NIGAM LUCKNOW ZONE 6

मृयु माण-प
DEATH CERTIFICATE

(जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया गया )

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH REGISTRATION OF BIRTHS &
DEATHS RULES 2002.)

यह मािणत कया जाता है ननलिखत सूचना मृयु के मूल अभलेख से ल गई है जो क नगर नगम लखनऊ े 6 तहसील लखनऊ िजला लखनऊ राय/संघ देश उर
देश,भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR NAGAR
NIGAM LUCKNOW ZONE 6 OF TAHSIL/BLOCK LUCKNOW OF DISTRICT LUCKNOW OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : ADITYA DHAMIJA लंग / SEX: पुरष / MALE

आधार नंबर / AADHAAR NO.:

XXXXXXXX3117

मृयु क तथ / DATE OF DEATH: मृयु का थान / PLACE OF DEATH:

10-01-2022 13/2 LAJPAT NAGAR CHOWK, LUCKNOW, LUCKNOW, LUCKNOW, UTTAR
TENTH-JANUARY-TWO THOUSAND TWENTY TWO PRADESH.

पत / पी का नाम / NAME OF HUSBAND / WIFE:

मृतक क उ / AGE OF DECEASED:
43 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER :

OM PRAKASH DHAMIJA

आधार नंबर / MOTHER'S AADHAAR NO. :

--- आधार नंबर / FATHER'S AADHAAR NO. :
---

मृयु के समय मृतक का पता / ADDRESS OF THE DECEASED AT THE TIME OF DEATH : मृतक का थायी पता / PERMANENT ADDRESS OF DECEASED :

13/2 LAJPAT NAGAR CHOWK, 13/2 LAJPAT NAGAR CHOWK,

LUCKNOW, LUCKNOW, LUCKNOW, LUCKNOW, LUCKNOW, LUCKNOW,
UTTAR PRADESH UTTAR PRADESH

पंजीकरण संया / REGISTRATION NO: पंजीकरण तारख / DATE OF REGISTRATION:

D-2022: 9-91811-000404 20-01-2022

टपणी / REMARKS (IF ANY):

A.K.PANDEY

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
09-04-2024
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
NAGAR NIGAM LUCKNOW ZONE 6
नगर नगम लखनऊ े 6

UPDATED ON :
2022-01-20 16:36:51

"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 DOUCMENT FOR ALL OFFICIAL PURPOSES.

" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "