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Ram Asre

This death certificate provides information about Ram Asre, a 58-year old male who passed away on November 4th, 2022 in Balipur, Churiyani, Balipur, Fatehpur, Uttar Pradesh. It lists his address, parents' names, registration details, and certifies that the information was taken from official death records. The certificate was issued on December 10th, 2022 by the Registrar of Births & Deaths of Grama Panchayat Fatehnagar Karsuma.

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Divyansh Singh 11A
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1K views1 page

Ram Asre

This death certificate provides information about Ram Asre, a 58-year old male who passed away on November 4th, 2022 in Balipur, Churiyani, Balipur, Fatehpur, Uttar Pradesh. It lists his address, parents' names, registration details, and certifies that the information was taken from official death records. The certificate was issued on December 10th, 2022 by the Registrar of Births & Deaths of Grama Panchayat Fatehnagar Karsuma.

Uploaded by

Divyansh Singh 11A
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 Certificate

सं.

1
No. 1
उर देश सरकार प-6
GOVERNMENT OF UTTAR PRADESH FORM-6
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

मृयु माण-प
DEATH CERTIFICATE

(जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002.)

यह मािणत कया जाता है ननलिखत सूचना मृयु के मूल अभलेख से ल गई है जो क ाम पंचायत फतेहनगर करसीमा तहसील फतेहपुर िजला फतेहपुर
राय/संघ देश उर देश,भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER
FOR GRAMA PANCHAYAT FATEHNAGAR KARSUMA OF TAHSIL/BLOCK FATEHPUR OF DISTRICT FATEHPUR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : RAM ASRE लंग / SEX: पुरष / MALE

मृयु क तथ / DATE OF DEATH: मृयु का थान / PLACE OF DEATH:


04-11-2022 BALIPUR, CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR, UTTAR
FOURTH-NOVEMBER-TWO THOUSAND TWENTY TWO PRADESH, 212601.

पत / पी का नाम / NAME OF HUSBAND / WIFE:


मृतक क उ / AGE OF DECEASED: PACHANIYA
58 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER :


BHAROSA

आधार नंबर / MOTHER'S AADHAAR NO. : आधार नंबर / FATHER'S AADHAAR NO. :

मृयु के समय मृतक का पता / ADDRESS OF THE DECEASED AT THE TIME OF मृतक का थायी पता / PERMANENT ADDRESS OF DECEASED :
DEATH :
BALIPUR,
BALIPUR, CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR,
CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR, UTTAR PRADESH- 212601
UTTAR PRADESH- 212601

पंजीकरण संया / REGISTRATION NO: पंजीकरण तारख / DATE OF REGISTRATION:


D-2022: 9-25560-000018 10-12-2022

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
10-12-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

UPDATED ON :
10-12-2022 [Link]

"THIS IS A COMPUTER GENERATED CERTIFICATE. "


THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.
" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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