Panchayat:Repo18/vol2-page0412

Registration No.:                                                                                                                                                                             Registration Date:                       

Registration Unit:
Town/Village:                                                                                                                          District:
Remarks (if any)                                                                                                                     Name and Signature of the Registrar.
FORM No. 8
[See Rule 12]

Form No. 2
DEATH REGISTER
DEATH REPORT
Legal information
This part to be added to the Death Register

To be filled by the informant
1. Date of Death: (Enter the exact day, month and year the death took place e.g. 1.1.2000)
2. Name of the Deceased: (Full name as usually written)
2A. Permanent address of the deceased
2B. Name of Father/Husband
2C. Name of Mother
2D. Address of the deceased at the time of the death
3. Sex of the deceased: (Enter Male' or 'Female' do not use abbreviation)
4. Age of the deceased: (if the deceased was over 1 year of age, give age in completed years. If the deceased was below 1 year of age, give age in months, and if below 1 month give age in completed number of days, and if below one day, in hours.)
5. Place of birth: (Tick the appropriate entry 1, 2 or 3 below and give the name of the Hospital/Institution or the address of the house where the death took place. If other place, give location.) 1. Hospital/                                                   Name:
                          Institution
2. House                                                   Address:
3. Other Place
6. Informant's name:
Address:
(After completing all columns 1 to 17 informant will put date and signature here:)
Date:                                                                                                     Signature or left thumb mark of the informant


To be filled by the Registrar

Registration No.:                                                                                                                                                       Registration Date:
Registration Unit:
Town/Village:                                                                                                     District:

Remarks (if any):
Name and Signature of the Registrar
FORM No. 9
[ See Rule 12]
STILL BIRTH REGISTER
STILL BIRTH REPORT
legal information

Form No. 3

This part to be added to the Still Birth Register

To be filled by the informant
1. Date of Birth: