Meeseva CDMA APPLICATION FOR DEATH CERTIFICATE

Download Meeseva CDMA APPLICATION FOR DEATH CERTIFICATE

The DEATH CERTIFICATE APPLICATION Form will be like below download the form and fill all the details and attach required documents:

APPLICATION FOR DEATH CERTIFICATE

(Write in Capital Letters)

CIRCLE / LOCALITY :

1. Date Of Death :

2. Name of the Deceased :

3. Sex of the Deceased :

4. Name of the Father of the deceased :

5. Name of the Mother :

6. Place of Death :

(Tick the appropriate entry a, b, c below and give the name of the Hospital/Institute or the

Address of the House where the Death took place. If other place give location)

a) Hospital/Institution Name :

b) House Address :

c) Other place :

7.No.of Copies Required :

8 a) Do you want the Death Certificate by Courier- Yes / No.

b) If Yes give Name and Address with Pin Code

Name & address. (Signature of the Applicant)

Telephone No:

Note:- Death certificate will be issued subject to entry found Registered with in DEATH

RECORDS-C&DMA/PANCHYATS.

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