Scribd
Upload
37 views

Application Form (Death) : For Office Use

Uploaded by

Beyza Gemici
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
37 views

Application Form (Death) : For Office Use

Uploaded by

Beyza Gemici
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
You are on page 1/ 1

APPLICATION FORM (DEATH)

To
The Registrar of Birth and Death and
City Health Officer,
Bhubaneswar Municipal Corporation,
Bhubaneswar.

Sub: Issue of DEATH CERTIFICATE.

Madam / Sir,
I submit herewith the following particulars for issue of Death Certificate on
payment.

1. Name of Deceased (in full) : _________________________________________


(in Capital Letter)

2. Name of Father/Husband : _________________________________________

3. Place of Death : _________________________________________

4. Date of Death :

5. Sex of Deceased : Male Female

6. Permanent Address of Deceased : _________________________________

_________________________________

7. Applicant’s Relation with Deceased : _________________________________

8. Present Address of Applicant : _________________________________

Signature of the Applicant

For Office Use

Regd. No : ________________ Date : ________________ Vol.No: _____________

Challan No : ________________________________ Date ____________________

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy