‫دروخاتسافرمرباےئویپمکرٹازئڈڈیتھررٹسجنشی‬

_________‫ویںینوکلسن_______________ربمن‬
_____________‫اٹ ُون_________________علض‬/‫ہقلعت‬

‫ویپمکرٹازئڈڈیتھررٹسجنشیےکوصحلےکےئلدرجزلیافرمرپرکےکہقلعتمرکیسرٹییوینینوکلسنےسراہطبرکںی۔‬

Nature of Death :

 Normal

 Still Birth

 Dead body found

Applicant Name ____________________________________

____________________________________‫دروخاتسددنہہاکانم‬

Applicant CNIC No. ________________________________

______________________________‫دروخاتسددنہہاکانشیتخاکرڈربمن‬

Deceased Name ____________________________________

______________________________________‫وتمہیفاکانم‬/‫وتمیف‬

Deceased’s CNIC No. _______________________________

________________________________‫وتمہیفاکانشیتخاکرڈربمن‬/‫وتمیف‬

Relation of applicant with Deceased ____________________

_________________________‫وتمہیفاک دروخاتسددنہہےسرہتش‬/‫وتمیف‬

Religion _________________ Gender __________________

_______________________‫ذمبہ___________________سنج‬

Father’s Name ______________________________________

___________________________________________‫وادلاکانم‬

Father’s CNIC No. __________________________________

_____________________________________‫وادلاک انشیتخاکرڈربمن‬

Mother’s Name_____________________________________

___________________________________________‫وادلہاکانم‬

Mother’s CNIC No. _________________________________

____________________________________‫وادلہاک انشیتخاکرڈربمن‬

Husband’s Name ____________________________________

___________________________________________‫وشرہاکانم‬

Husband’s CNIC No. ________________________________

____________________________________‫وشرہاک انشیتخاکرڈربمن‬

Graveyard Name ___________________________________

_________________________________________‫ربقاتسناکانم‬

Date of Birth _______________________________________

_________________________________________‫اترخیدیپاشئ‬

Date of Death _____________ Date of Burial _____________

____________________‫اترخیوافت_______________اترخیدتنیف‬

Mother’s Date of Birth _______________________________

____________________________________‫وادلہیکاترخیدیپاشئ‬

Previous Still Birth __________________________________

____________________________________‫زگہتشدیپایشئاومات‬

Period of Intra-uterine existence _______________________

_________________________________________‫لمحاکدوراہین‬

Sickness period ____________________________________

_________________________________‫امیبریاکدوراہین‬/‫دمتتلع‬

Reason of Death ____________________________________

___________________________________________‫وہجوافت‬

Address ___________________________________________

_______________________________________________‫ہتپ‬

__________________________________________________

_________________________________________________

Person name causing Disposal of Body __________________

__________________________________________‫دتنیفدننکہ‬

Person’s CNIC No. __________________________________

________________________________‫دتنیفدننکہاک انشیتخاکرڈربمن‬

Doctor / Mid Wife’s Name ___________________________

_______________________________________‫دایئاکانم‬/‫ڈارٹک‬

‫درتفیاامعتسلےئلیک‬
THE ENTRY OF THE SAID DATE IS ACCORDING TO THE STATEMENT FURNISHED BY THE INFORMING PERSON/INSTITUTION.
This extract to Mr. /Mrs. ________________________________________ has been issued vide application dated ________________
Rs. __________ regarding fees for the registration/extract has been received vide receipt no. ____________ dated ________________
Book No. ___________ Entry No. __________________ Dated: ____________

Signature of UC Secretary ___________________

Checked by______________ SD________

Birth, Deaths, Marriages and Divorces

(Name & Signatures)

Union Administration _____________(No.___________)

Date of Issuance: ____________________

CRMS No.

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