Thanks to visit codestin.com
Credit goes to www.scribd.com

Scribd
Upload
5 views1 page

Death Certificate: Government of Uttar Pradesh Department of Medical and Health Nagar Nigam Dashaswmedh Jone

This document is a death certificate issued by the Government of Uttar Pradesh for an individual named Shakuntala Devi, who passed away on December 2, 2023, at Galaxy Hospital in Varanasi. It includes details such as the deceased's age, parent's names, and addresses at the time of death. The certificate is officially registered and recognized as a valid legal document for all official purposes.

Uploaded by

chefpriyanshiagrawal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
5 views1 page

Death Certificate: Government of Uttar Pradesh Department of Medical and Health Nagar Nigam Dashaswmedh Jone

This document is a death certificate issued by the Government of Uttar Pradesh for an individual named Shakuntala Devi, who passed away on December 2, 2023, at Galaxy Hospital in Varanasi. It includes details such as the deceased's age, parent's names, and addresses at the time of death. The certificate is officially registered and recognized as a valid legal document for all official purposes.

Uploaded by

chefpriyanshiagrawal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

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 दशावमेध जोन
NAGAR NIGAM DASHASWMEDH JONE

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 दशावमेध जोन तहसील वाराणसी िजला वाराणसी 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 DASHASWMEDH JONE OF TAHSIL/BLOCK VARANASI OF DISTRICT VARANASI OF STATE/UNION TERRITORY UTTAR PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : SHAKUNTALA DEVI लंग / SEX: महला / FEMALE

आधार नंबर / AADHAAR NO.:


XXXXXXXX6402

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


02-12-2023 GALAXY HOSPITAL(UNIT OF GALAXY LIFE CARE SERVICES PVT
SECOND-DECEMBER-TWO THOUSAND TWENTY THREE LTD) PV)

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


मृतक क उ / AGE OF DECEASED: LATE. JAGMOHAN DAS AGRAWAL
73 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :

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


LATE. GANGOTRI DEVI LATE. SOHAN LAL AGRAWAL

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 :

PLOT NO 4,5,6,7, GALAXY HOSPITAL, DAYAL ENCLAVE MAHMOORGANJ, D53/90-J, , NARAYAN NAGAR, GURUBAGH,
VARANASI, VARANASI, VARANASI, VARANASI, VARANASI, VARANASI,
UTTAR PRADESH- 221010 UTTAR PRADESH- 221001

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


D-2023: 9-93828-002323 16-12-2023

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
27-12-2023
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
नगर नगम दशावमेध जोन
NAGAR NIGAM DASHASWMEDH JONE

UPDATED ON :
16-12-2023 00:00:00

"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 "

You might also like