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POo-6
GOVERNMENT OF ANDHRA PRADESH FORM-6

DEPARTMENT ÖF HEÁLTH, MEDICAL AND FAMILY WELFARE

GOVERNMENT GENERAL HOSPITAL GUNTUR

DEATH CERTIFICATE

assUEDUNDERSECTION 12/17 0F THE RECISTRATIOoN oF BIRTHS& DEATHS ACT, 1963 AND RULE 8/13 OP THE ANDHRA PRADESH RECISTRATON 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 REGSTER FOR
GOVERNMENTGENERAL HOSPITAL GUNTUR OF TAHSILBLOCK GUNTUR OF DISTRICT GUNTUR OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

ssotoo iss b / NAME OF DECEASED : SUBRAHMANAM P Oorisw/ SEX: DDDOO/ MALE

votao d / DATE OF DEATH: bdtaoas S s o / PLACE OF DEATH:

15-01-2021 GOVERNMENT GENERAL HOSPITAL GUNTUR
FIFTEENTHJANUARY-TWo THOUSAND TWENTY ONE
d aros d ) NAME OF HUSBAND/ WIFE:

sootaoas áss, » s sabs/ AGE OF DECEASED:

68 YEARS esc oans5 HUSBAND/WIFE AADHAAR NO.

so d NAME OF MOTHER: s o o NAME OF FATHER:

AKASAM
sró So,S MOTHER'S AADHAAR NO. :
esrQ Soas FATHER'S AADHAAR NO.

sodtoobskbd iyáo Drir IADDRESS OF THE DECEASED ATTHE TIME OF DEATH: ds)R,Ss) Ksr IPERMANENT ADDRESS OF DECEASED

POTHARLANKA, KOLLUR, GUNTUR

ANDHRA PRADESH POTHARLANKA, KOLLUR, GUNTUR,
ANDHRA PRADESH

S r a Soas /REGISTRATION NO0: Sdra sd/ DATE OF REGISTRATION:

D-2021: 28-90111-001321 01-02-2021

3arobow/REMARKS (IF ANY):

3 30/DATE OF ISSUE: S o s etds0 Sodso / ISSUING AUTHORITY

26-02-2021
(es55voea dar )
REGISTRAR (BIRTH & DEATH)
GOVERNMENT GENERAL HOSPITAL GUNTUR

UPDATED ON :
2021-02-01 20:48:37

"THIS IS ACoMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILESIGNATURE 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.

ENSURE REGISTRATION OF EVERY BIRTH AND DEATH"