सं.

1
मय देश सरकार
No. 1
प-6
GOVERNMENT OF MADHYA PRADESH FORM-6
योजना, आिथक एवं सांियक वभाग
DEPARTMENT OF PLANNING, ECONOMICS & STATISTICS
नगर नगम भोपाल
MUNICIPAL CORPORATION BHOPAL

मृयु माण-प
DEATH CERTIFICATE

(जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा मय देश जम मृयु रिजकरण नयम, 1999 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 MADHYA PRADESH REGISTRATION OF BIRTHS &
DEATHS RULES 1999.)

यह मािणत कया जाता है ननलिखत सुचना मृयु के मूल अभलेख से ल गई है जो क नगर नगम भोपाल तहसील हुज़ूर िजला भोपाल राय/संघ देश मय 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 MUNICIPAL
CORPORATION BHOPAL OF TAHSIL/BLOCK HUZUR OF DISTRICT BHOPAL OF STATE/UNION TERRITORY MADHYA PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : KALICHARAN GARHWAL लंग / SEX: पुरष / MALE

आधार नंबर / AADHAAR NO.:

XXXXXXXX7487

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

11-01-2021 CHAIRYU MEDICAL , HOSPITAL, BHOPAL, BHOPAL, HUZUR, BHOPAL,
ELEVENTH-JANUARY-TWO THOUSAND TWENTY ONE MADHYA PRADESH.

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

मृतक क उ / AGE OF DECEASED: SHASHI BAI GARHWAL
73 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :
8415 2295 1248

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

JIJIYA BAI PARAMSUKH GARHWAL

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 :

H.NO 251 POST TEH-, PIPARIYA RAI KHEDI ROAD HANUMAN MANDIR KE SAMNE , WARD H.NO 251 POST TEH-, PIPARIYA RAI KHEDI ROAD HANUMAN MANDIR KE
NO 06 HOSHANGABAD, SAMNE, WARD NO 06 HOSHANGABAD,
PIPARIYA, PIPARIYA, HOSHANGABAD, PIPARIYA, PIPARIYA, HOSHANGABAD,
MADHYA PRADESH- 461775 MADHYA PRADESH- 461775

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

D-2021: 23-90235-002517 30-01-2021

टपणी / REMARKS (IF ANY):

---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
30-01-2021
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
MUNICIPAL CORPORATION BHOPAL
नगर नगम भोपाल

UPDATED ON :
2021-01-30

"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 "