No. B . B . M .
P 4 5 2 8 7 0 4
Form6
Government of India
GOVERNMENT OF KARNATAKA
Chlef Registrar of Births and Deaths
(.0.RD YRO, 1969d 12/78ats otdo oo .o.5).öAE, Nabaorso 1999d aooab 8//3d abeæn odoDO)
DEATH CERTIFICATE
his is to certify that the following information has been taken from the original record of death which ís the
village/town)of Bengaluru Urban district of Karnataka State register for BBMP
2) dor dod
DR R SREENIVAS Sex Male
07/03/2025 4) abdad ãy
Pate of Death
Place of Death
TRUSTWELL HOSPITAL,CHIKPETE,
a O R E
BBMP,,Bengaluru Urban, Karnataka
Vae of Mother N LAKSHM0DEVAMMA Name of the Father B RAMAPPA
ame of the Hustband/Wife K MALATHI
ioo.d,, aorio), BNFJJ S60o43
ed.d.wo.&,, woridod wFW8 560043
Address of deceased at the time of death: Permanent address of the deceased:
O 95. P SQUARE HOMES, NEAR BANASVWADI BUS NO 95, P SQUARE HOMES, NEAR BANASWADI
STOP, BANASWADI MAIN ROAD, BBMP,,Bengaluru STOP, BANASWADI MAIN ROAD, BBMP,BengalurBS
rban,Karnataka 560043 Urban, Karnataka 560043
803162/B/DI2025/020369 18/03/2025
egistration No.: Date of Registration:
18/03/2025
einarks(if any) Date of Approval
gnalure of Issuing Authurily Address of the issuing authority Medical Officer
CHICKPET, Bengaluru Urban District
Date of lssue 01/0412025
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