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 SONAI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION
TERRITORY ASSAM INDIA.

NAME OF DECEASED : SULTANA BEGUM LASKAR SEX: FEMALE

DATE OF DEATH PLACE OF DEATH:

19-12-2022 SONABARIGHAT PT II P.O. SONABARIGHAT
NINTEEN DEC TWO THOUSAND CACHAR, ASSAM - 788013
TWENTY TWO

AGE OF DECEASED: NAME OF HUSBAND/WIFE:

44 YEARS NAZIM UDDIN LASKAR
HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER: NAME OF FATHER:

MOTHER’S AADHAR NO: FATHER’S AADHAR NO:

ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED:

SONABARIGHAT PT II P.O. SONABARIGHAT SONABARIGHAT PT II P.O. SONABARIGHAT

CACHAR, ASSAM - 788013 CACHAR, ASSAM - 788013

REGISTRATION NO: DATE OF REGISRTAION:

D:2023 18-12394-551244 07-02-2023

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY
25-02-2023 REGISTRAR (BIRTH & DEATH)
SONAI PRIMARY HEALTH CENTRE
UPDATED ON:
25-02-2023 02:26:15

“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”