to

the
Investigating officer Police station Ajami
Reference
Name -
ABC

Age stated B- Sex Mate occupation student

Address JawaharNagar.Manewada_
Brought by Police constable Deepak No 514 Ps :
Ajani
Identified by Policeconshble
Date and time of examination -11

Place of examination Department of FMT , GMCH Ngp

Consent : -

ji zealot delist aerie * AT desert E- 1

Identification mark i tattoo of board Shiva over lateral aspect

of right forearm
27 black mole over dorsum of left hand .

Edu upto I class

-
.

examination
physical
Height 140am weight 35kg .

General build and appreance -

normal .

Hair
pubic -
No
Axillary -
No facial No .

Development of breast - not applicable .

Development of genitals stage 3 developed .

 Onset of
puberty .

Voice → Adult like Adam's apple

-

weltdoped .

Dental status -
28 permanent teeth .

Any other finding

Skin N -
.

Eye N
other Nil

Adised
X-ray
✗
plate No Date
ray
Provisional Certificate
Age
On Clinical examination of the individual , about
ageshould be ¥51
is
years .

However, the final

opinion regarding the collected
from this olhiee alter submission ofage
the
Radiological report
and the birth certificate .

Name
signature
place
Dade .
Designation

Age Certificate
to
the
Investigating officer Police station Ajami
Rebane
Age estimation
: of ABC dated .

Sir
the findings
.

I. Dr _
alto
going through .
of ABC

physical examination Report No .

Date
✗
ray plate No

Radiological extermination report No Dok

and the Dole ofpoirth Certificate

No -
Dote -

produce before me

fam tithe opinion that

the individual 's
◦
age
is about É
year
.

Sign
place Dr

Designation
Dote

DEVCahih.ch
I do
hereby certify that the person whose particular are
given
below died in Hospital on 25-6-2012 at 6am

Name of the deceased ✗ 412

Address of normal Residente : -
Shree
nagar ,
Nandan van
Ngp
Gee 30
Age .fr BOB ,
Martial Occupation Religion
status teacher
Marriot

cause of death
ilfmmediokcaye ay internal tremorraged shock
due to
rupture otfolopianhbe
27 Antecedent cause ectopic pregnancy
 amenorrhea months
34 Other significant
condition
.

_
-3

Lf female
was death associated with
pregnancy yes
was these
dekvery -
No

Nance ofiighhiihon
GMCHNGP
Dr
fig .

Dateline :

Designation/seal

certified that stiff Wotan '

admitted tother hospital and

_ -

Resident of _
was

expire on _
at

fig
Dok line : or

Designation .