Form-6

GOVERNMENT OF WEST BENGAL

DEPARTMENT OF HEALTH AND FAMILY WELFARE

KOLKATA MUNICIPAL CORPORATION

DEATH CERTIFICATE

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE WEST BENGAL
REGISTRATION OF BIRTHS & DEATHS RULES 2000.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR KOLKATA MUNICIPAL CORPORATION OF BLOCK/MUNICIPALITY KOLKATA MUNICIPAL CORPORATION OF
DISTRICT KOLKATA OF STATE WEST BENGAL, INDIA.

NAME OF DECEASED : SADHAN KUMAR SEX : MALE

BORAL

DATE OF DEATH : 06/01/2023 PLACE OF DEATH : 375,PRINCE ANWAR SHAH ROAD,SOUTH

CITY,TOWER-3,FL NO.-12H,JODHPUR
PARK,KOLKATA MUNICIPAL
CORPORATION, KOLKATA, KOLKATA,
WEST BENGAL - 700068

AGE OF DECEASED : 87 YEARS NAME OF SPOUSE :

SPOUSE IDENTITY PROOF. : -

NAME OF MOTHER : NAME OF FATHER : LATE KALIDAS BORAL

MOTHER'S IDENTITY PROOF : - FATHER'S IDENTITY PROOF : -

ADDRESS OF THE DECEASED AT HOUSENO:- 375,STREET/LANE:- PRINCE ANWAR SHAH ROAD,SOUTH CITY,TOWER-3,FL NO.-
THE TIME OF DEATH : 12H,LOCALITY:-JODHPUR PARK, VILLAGE/TOWN:- KOLKATA,KOLKATA MUNICIPAL
CORPORATION,DIST:- KOLKATA,WEST BENGAL-700068

PERMANENT ADDRESS OF HOUSENO:-38/5,STREET/LANE:-BHUBAN MOHAN ROY ROAD,BAIDYA PARA,VTC PURBA

DECEASED : BARISHA,PO-BARISHA, VILLAGE/TOWN:- KOLKATA, KOLKATA MUNICIPAL CORPORATION,DIST:-
KOLKATA,WEST BENGAL-700008

CERTIFICATE NO : D/2023/015492 DATE OF REGISTRATION : 07/01/2023

REMARKS (IF ANY) :

DATE OF ISSUE : 07/01/2023 ISSUING AUTHORITY :

UPDATED ON : 2023-01-07 01:14:17

Signature Not Verified

Digitally Signed.
Name: BIMAN CHANDRA PAL
Date: 07-Jan-2023 01:16:42

SUB-REGISTRAR (BIRTH & DEATH)

KOLKATA MUNICIPAL CORPORATION

"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 "