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Death Certificate Application Form

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onestepsolution985
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204 views1 page

Death Certificate Application Form

Uploaded by

onestepsolution985
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

DEATH APPLICATION FORM

Application No. _____________


[Link]. _____________
Date _____________
To
The Registrar ,Birth & Death
Bhadrak Municipality
Bhadrak

Sir/Madam,

A death certificate in favour of my father/husband/wife/son/daughter as mentioned


below may please be issued on payment of required fees.

1) Name of deased person (Block Letter) : ……………………………………………………………………….

2) Father’s Name (Block Letter) :……………………………………………………………………….

3) Permanent Address : …………………………………………………………………………………….

4) Date of Death : ……………………………………

5) Place of Death : ………………………………………………………………………………………………

6) Sex :……………………………………….

7) Full name of the applicant with address :


………………………………………………………………………………………………………………………

8) Relation to the deased : ……...………………………………………………………………………

9) Mobile Number : ……………………………………………………………………..

N.B. No change or Correction will be entertained after the registration of the name of the
person who deased.

Full signature of the applicant


Date :

Common questions

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Applicants should ensure that the name of the deceased, father's name, permanent address, date and place of death, sex, and the full name and address of the applicant are accurately filled in. This is crucial because no changes or corrections will be entertained after the registration of the deceased person's name .

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