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This document is a death certificate for Samsun Nessa, a 45-year-old female who died on April 5, 2023 in Lathimara, Nazat Pur, Katigora Cachar, Assam, India. The certificate provides her identifying information including name, date of birth, parents' names, address, and registration number. It was issued by the Registrar of Births and Deaths at the Katigorah Primary Health Centre on June 5, 2023.

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694 views1 page

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This document is a death certificate for Samsun Nessa, a 45-year-old female who died on April 5, 2023 in Lathimara, Nazat Pur, Katigora Cachar, Assam, India. The certificate provides her identifying information including name, date of birth, parents' names, address, and registration number. It was issued by the Registrar of Births and Deaths at the Katigorah Primary Health Centre on June 5, 2023.

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Katigorahmphcc
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FROM-6

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

NAME OF DECEASED : SAMSUN NESSA SEX: FEMALE


AADHAAR NO. :
XXXXXXXX3491
PLACE OF DEATH:
DATE OF DEATH PO- LATHIMARA, NAZAT PUR, KATIGORA CACHAR, ASSAM
05-04-2023
FIVE- APR-TWO THOUSAND TWENTY THREE
NAME OF HUSBAND/WIFE
MAHADDICH ALI:
AGE OF DECEASED:
45 YEARS HUSBAND /WIFE AADHAR NO:

NAME OF MOTHER: NAME OF FATHER:


SUNGUL BIBI TAJAMUL ALI
FATHER’S AADHAR NO:
MOTHER’S AADHAR NO:
PERMANENT ADDRESS OF DECEASED:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH

PO- LATHIMARA, NAZAT PUR, KATIGORA CACHAR, PO- LATHIMARA, NAZAT PUR, KATIGORA,
ASSAM, CACHAR, ASSAM,

REGISTRATION NO: DATE OF REGISRTAION:


D-2023: 18-00690-000990 05-06-2023

REMARKS (IF ANY):


---
DATE OF ISSUE: ISSUING AUTHORITY
05-06-2023 REGISTRAR (BIRTH & DEATH)
KATIGORAH PRIMARY HEALTH CENTRE
UPDATED ON:
05-06-2023 02:26:20

“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 DOCUMENT FOR ALL OFFICIAL PURPOSES.
“ENSURE REGISTRATION OF EVERY BIRTH AND DEATH”

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