FROM-6
GOVERNMENT OF ASSAM
                               DEPARTMENT OF HEALTH AND FAMILY WELFARE
                                 SONABARIGHAT SUBSIDIARY HEALTH CENTRE
                                                 DEATH CERTIFICATE
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969AND RULE 8/13 OF THE ASSAM
REGISTRATION OF BIRTHS & DEATHS RULES 1999)
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS
THE REGISTER FOR SONABARIGHAT SUBSIDIARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/
UNION TERRITORY ASSAM INDIA.
NAME OF DECEASED : KUKILA BEGUM                               SEX: FEMALE
AADHAAR NO. :
XXXXXXXX5944
                                                             PLACE OF DEATH:
DATE OF DEATH
26-06-2023                                                   SILDUBI GRANT PART - I, SILCHAR,
TWENTYSIX JUN TWO THOUSAND                                   CACHAR, ASSAM - 788112
TWENTY THREE
AGE OF DECEASED:                                             NAME OF HUSBAND/WIFE:
                                                             MOHIB UDDIN
42 YEARS
                                                             HUSBAND /WIFE AADHAR NO:
NAME OF MOTHER:                                              NAME OF FATHER:
MOTHER’S AADHAR NO:                                          FATHER’S AADHAR NO:
ADDRESS OF THE SECEASED AT THE TIME OF DEATH                 PERMANENT ADDRESS OF DECEASED:
SILDUBI GRANT PART - I, SILCHAR,                             SILDUBI GRANT PART - I, SILCHAR,
CACHAR, ASSAM - 7880112                                      CACHAR, ASSAM - 788112
REGISTRATION NO:                                             DATE OF REGISRTAION:
D:2023   18-12894-001040                                     21-08-2023
REMARKS (IF ANY):
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DATE OF ISSUE:                                                ISSUING AUTHORITY
21-08-2023                                                            REGISTRAR (BIRTH & DEATH)
                                                               SONABARIGHAT SUBSIDIARY HEALTH CENTRE
UPDATED ON:
21-08-2023   02:06:15
                                    “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 DOCUMENT FOR ALL OFFICIAL PURPOSES.
                                    “ENSURE REGISTRATION OF EVERY BIRTH AND DEATH”