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GOVERNMENT OF ASSAM
DEPARTMENT OF HEALTH SERVICES
NUTAN RAMNAGAR STATE DISPENSARY

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 NUTAN RAMNAGAR STATE DISPENSARY OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION
TERRITORY ASSAM INDIA.

NAME OF DECEASED : SAHAB UDDIN SEX: MALE

DATE OF DEATH PLACE OF DEATH:

22-12-2020 DAKSHIN MOHANPUR PT V, SONAI
TWENTY TWO DECEMBER TWO THOUSAND CACHAR, ASSAM - 788119
TWENTY

AGE OF DECEASED: NAME OF HUSBAND/WIFE:

85 YEARS LT. LATIB UDDIN
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:

DAKSHIN MOHANPUR PT V, SONAI DAKSHIN MOHANPUR PT V, SONAI

CACHAR, ASSAM - 788119 CACHAR, ASSAM - 788119

REGISTRATION NO: DATE OF REGISRTAION:

D:2022 18-01751-001102 13-12-2021

REMARKS (IF ANY):

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DATE OF ISSUE: ISSUING AUTHORITY
18-01-2022 REGISTRAR (BIRTH & DEATH)
NUTAN RAMNAGAR STATE DISPENSARY
UPDATED ON:
18-01-2022 11:44:11

“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”