Panchayat:Repo18/vol2-page0412
Registration No.: Registration Date:
Registration Unit:
Town/Village: District:
Remarks (if any) Name and Signature of the Registrar.
Form No. 2
To be filled by the informant
1. Date of Death: (Enter the exact day, month and year the death took place e.g. 1.1.2000)
2. Name of the Deceased: (Full name as usually written)
- 2A. Permanent address of the deceased
2B. Name of Father/Husband
2C. Name of Mother
2D. Address of the deceased at the time of the death
3. Sex of the deceased: (Enter Male' or 'Female' do not use abbreviation)
4. Age of the deceased: (if the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months, and if below 1 month give age in completed number of days, and if below one day, in hours.)
5. Place of birth: (Tick the appropriate entry 1, 2 or 3 below and give the name of the Hospital/Institution or the address of the house where the death took place. If other place, give location.) 1. Hospital / Name:
Institution
2. House Address:
3. Other Place
6. Informant's name:
Address:
(After completing all columns
1 to 17 informant will put date
and signature here:)
Date: Signature or left thumb mark of the informant
Registration No.: Registration Date: Registration Unit: Town/Village: District: Remarks (if any): Name and Signature of the Registrar FORM No. 9 See Rule 12) STILL BRTHREGISTER STI brTHREPORT legal information Form No. 3 This part to be added to the Still Birth Register To be filled by the informant 1. Date of Birth:
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ഈ താൾ 2018 -ലെ പഞ്ചായത്ത് റെപ്പോ നിർമ്മാണം യജ്ഞത്തിന്റെ ഭാഗമായി സൃഷ്ടിച്ചതാണ്. |