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MAHABUBNAGAR MUNICIPALITY
APPLICATION FoR igsUE OF DEATH CERTIFICATE
EETLICATION For issue OF DEATH CERTIFICATE
Application No,
1) | Name of the Registration unit |] -——— Mahabubnagar Municipality
2) | Registration Year (if already taken)
3) | Registration No.
4) | Registration Date
(if already taken)
eal (if already taken)
“ beceesaat sre
5) | Name ofthe Deceased
6) _ | Sex =
Male/Female |
7) | Date of Death
8) | Place of Death “
| 9)_ | Residential Address of
Deceased
10) | Mother's name of Deceased cy
11) | Father's/Husband’s name of ] : tT
Deceased
12) | Name and Address of the i
applicant with Mobile No. &
email ID ce
.
13) | Relationship with Deceased
Encl: 1) Hospital Certificate if any;
2) Any other proof in support of this claim Yours faithfully
3) Applicants 1D proof, Aadhar-card/ Ration cary ifany.
cwweremnenm—= FOR OFFICE PURPOSE ONLY -.
Note submitted,
The above application is pursued SSE topo tabiated by thes oe
office/ Hospital death dectarationalong with aq, ced ae this
"relevant documents enclosed, it may be digitalh
signed in online, to issue death certificate eager ce Naege
JA, — Aso
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