FROM-6

GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH AND FAMILY WELFARE
NARSINGPUR MINI 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 & 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 NARSINGPUR MINI PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/
UNION TERRITORY ASSAM INDIA.

NAME OF DECEASED : FAJU RAHMAN LASKAR SEX: MALE

AADHAAR NO. :
XXXXXXXX1234
PLACE OF DEATH:
DATE OF DEATH
28-04-2023 BOALJUR, KAJIDAHAR PT III, SONAI,
CACHAR, ASSAM - 788119
TWENTYEIGHT APR TWO THOUSAND
TWENTY THREE
NAME OF HUSBAND / WIFE:
AJIBUN NESSA LASKAR
AGE OF DECEASED:
43 YEARS
HUSBAND /WIFE AADHAR NO:

NAME OF MOTHER: NAME OF FATHER:

RAHMAN ALI LASKAR

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

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

BOALJUR, KAJIDAHAR PT III, SONAI, BOALJUR, KAJIDAHAR PT III, SONAI,

CACHAR, ASSAM - 78801 CACHAR, ASSAM - 7880120

REGISTRATION NO: DATE OF REGISRTAION:

D:2023: 18-01911-000198 18-09-2023

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY

18-09-2023
REGISTRAR (BIRTH & DEATH)
NARSINGPUR MINI PRIMARY HEALTH CENTRE
UPDATED ON:
18-09-2023 12:06:15

“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”