OFFICIAL DOCUMENT FOR COVID - 19 DEATH

(Issues in compliance to the Hon'ble Supreme court Judgement dated 30th June 2021 in WP(Civil) No.539 & WP(Civil) 554 of
2021)

Shri/Smt./Kum V SRINIVASULU s/w/d of Shri V ANJAIAH R/O 7-8-60/1,

SRINAGAR COLONY
PANAGAL NALGONDA, Nalgonda, Nalgonda, NALGONDA. expired on 10-05-2021 at Hospital . This
death is registered vide registration number in the office of Registerar of Births and Deaths

The Covid-19 Death Ascertaining Committee (CDAC) hereby certifies that the said person"Died due to
COVID-19"

Name and Signature of the Chairman of CDAC

Place of Issue: NALGONDA

Document No : APLN022100051960
PRASHANTH JEEVAN PATIL. I.A.S
Date of Issue :25/01/2022

To:
1) The fam ily m em ber of the deceased (Nam e & address), who applied to the CDAC.
2) Registerar of Birth & Death, who issued the death certificate
3) Chief Registrar of Birth & Death of the concerned State/UT

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