FORM

e RuleNa.b
GOVERNMENT OF KERALA
DEPARTMENT OF
PANCHAYATS/URDAN AFFAIRS
tare tf Votal body ssuing
tertilicate
hiru
3un udslarLo apur Cor poration
DEATH CERTIFICATE
-tIR teti-imrt talvueiin (sued Unider Section 12)

ertOn 12 othe kegistration of Birttis and Deattrs Atts, 1969 and Rule
o n a 0/13
atns Mules, 1999) te Keraa

This is to certity th a n A
tie regster tor Thiruvananthepuram Co a n rur he otgihal rerord ur Death wlicth is

Thiruvananthapuram
am of District
Destrict Thiruvanantha
of o c a t tody) of Tahuk
Thilruvananthapuram o stnte Ketas
Gnls/iamee
janaa) niDanlo / Muhammed Ibrafirn
mgn/ornsab/ Sex
n Male
aan ium/bate of Death
11/04/2019
tutvEn APRIL/ TWO
m
murDb/Place of Death THOUSAHD NIiETEEH )
t.30emnlil, ilnnim7nij9s/ Medical
99niand Gais /Name of Mother
College Hospital, Thiruvananthapurem
anraln pam / Hajra Umma
llmnlun an5jeiannilan n39l nomin0 (nlonl) / Muhammed Hancefa (Fathe)
Gal/ Name of
Father/Husband
0i ljos 0apveuom p ngni animuias, si mul as/219, nloan;91, an-qins mr,

695076,/011ojnimnnlo,0biog.0ninus
Address of the deceascd at the MFManzil, T C48/239, Paruthikuzhi, We-One Nagar,
inie of deatl
695026Thi in
nruvanantndpuram,xerala, India
n0 l andmuiss, si qul a/239, ajomleav,an-d mn,
G23ilkDTUO
(mmirno, n nl 4, njlns
tus026,011a)nit )0,Gago
Permanent address of deceascd
MF Manzil, T C48/239, Paruthikuzhi,We-One Nagar,
P0, Pin
ra
S026T
Du6,1hiruvananthapuram,Kerala 0
acioSt mm :4966/2019 ariesnsoln :14/04/2019
Registration No Date of Registration

aDalni olal/Remarks (it any)

****************************************sssasssd"**************as* *i*ssss*
m i a l Date of issue 14/04/2019

ing authority TK PÁDMAKUMAR

alth Inspector Gre
ub
Registrar Births &Dealns
cSalennia unicipal orporatid
niruvänanthapuramn
the is
E u r e Registration
n oof r Every blrth and death
Page 1 of 1

amaieswafam,
BRN
r e *

n s

o
Rat