FROM-6

GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH SERVICES
HARINA NEW 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 7 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 HARINA NEW PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF
STATE/UNION TERRITORY ASSAM INDIA.

NAME OF DECEASED : JAYNUL HAQUE MAZUMDER SEX: MALE

DATE OF DEATH PLACE OF DEATH:

22-08-2022 ISLAMABAD, P.O. BHAGA BAZAR
TWENTY TWO AUGUST TWO THOUSAND TWENTY TWO CACHAR, ASSAM - 788114

AGE OF DECEASED: NAME OF HUSBAND/WIFE:

25 YEARS
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:
JAKAN ALI MAZUMDER
MOTHER’S AADHAR NO: FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:
ISLAMABAD, P.O. BHAGA BAZAR ISLAMABAD, P.O. BHAGA BAZAR
CACHAR, ASSAM - 788114 CACHAR, ASSAM - 788114

REGISTRATION NO: DATE OF REGISRTAION:

D:2022 18-12394-558259 20-09-2022

REMARKS (IF ANY):

---

DATE OF ISSUE: ISSUING AUTHORITY

27-09-2022 REGISTRAR (BIRTH & DEATH)

HARINA NEW PRIMARY HEALTH CENTRE
UPDATED ON:
27-09-2022 11:26:55

“THIS IS A COMPUTER GENERATED CERTIFICATE”

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”