1.

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GOVERNMENT OF HARYANA FORM-6

DEPARTIMENT OF HEALTH SERVICES

MUNICIPAL CORPORATION PANCHKULA

DEATH CERTIFICATE

HY zfiiar fAyA, 2002 fqA 8/13 s a rt faT TTT )

(H Hes tfgay fafa4H, 1969 TT 12 / 17 TT fruT H
HARYANA REGISTRATION OF BIRTHS &
BIRTHS & DEATHS ACT 1969 AND RULE 8/13 OF THE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF
DEATHS RULES 2002.)

INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR
THIS IS TO CERTIFY THAT THE FOLLOWING
TAHSILBLOCK PANCHKULAOF DISTRICT PANCHKULAOF STATE/UNION TERRITORY HARYANA, INDIA.
MUNICIPAL CORPORATION PANCHKULA OF

HHS h H NAME OF DECEASED : KULDIP SINGH DATTA fa / SEX: qeq/ MALE

AIT T/ AADHAAR NO.:
XXXXXXXX7932
HeY aT RIT /PLACE OF DEATH:
Hcq fafRr / DATE OF DEATH: 662. SECTOR-19, PANCHKULA, PANCHKULA, PANCHKULA, HARYANA.
08-12-2021
EIGHTH-DECEMBER-TWO THOUSAND TWENTY ONE uf / yt aÊ H NAME OF HUSBAND / WIFE:
SNEH LATA
HdG 34 |AGE OF DECEASED: TETT 4T / HUSBAND/WIFE AADHAAR NO. :
82YEARS 5419 2329 0924

1 A / NAME OF M THER: fuT a HINAME OF FATHER:

RAN SINGH DATTA
KRISHNA DEVI

3ATETT r MOTHER'S AADHAAR NO. : 3AT¬/TT GT / FATHER'S AADHAAR NO. :

THE TIME OF DEATH: Hd# oT RITT aI /PERMANENT ADDRESs OF DECEASED

HeY 4H4 HaF I YT /ADDRESS OF THE DECEASED AT
#662, SECTOR-19, V.P.O-KHAD,
PANCHKULA, PANCHKULA, PANCHKULA, HAROLI, HAROLI, UNA,
HIMACHAL PRADESH
HARYANA

s T iGAI | REGISTRATION NO:

i q fta|DATE OF REGISTRATION:
30-12-2021
D-2021:6-90007-001805

euyt / REMARKS (UP ANY):

DEATH CEKTIFICATE

Iâ fr fafy/ DATE OF ISSUE: rt aà aI ufyarft / ISSUING AUTHORITY

30-12-2021
REGISTRAR (BIRTH & DEATH)
MUNICIPAL CORPORATION PANCHKULA

UPDATED ON:
2021-12-30 12:32:05

THIS IS A
COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS AVALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.

yt HrÝ H Vy r f a / ENSURE REGISTRATION OF EVERYBIRTH AND DENTIH"