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Iz i la- 6 FORM NO. 6 e R q izek. k i k DEATH CERTIFICATE tUe vkSj e R q jftLV hdj. k vf/kfu e 1969 dh /kkjk 12 17 vkSj jktLFkku tUe vkSj e R q jftLV hdj. K fu e 2000 ds fu e 8 13 ds v/khu tkjh fd k x k Issued under Section 12/17 of the Registration of Births and Deaths Act 1969 and Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules 2000 g izekf.kr fd k tkrk gS fd fuEu fyf kr lwpuk e R q ds ewy vfHkys k ls yh xbZ gS tks fd LFkkuh ks k LFkkuh fudk --------------------------------------------------------- rglhy k. M---------------------------------------------------------------------------- ftyk ---------------------------------------------------------------------------------------jkT -- la k jkT ks k --------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of death which is the register for local area / local body. k fu e 2000 ds fu e 8 13 ds v/khu tkjh fd k x k Issued under Section 12/17 of the Registration of Births and Deaths Act 1969 and Rule 8/13 of the Rajasthan Registration of Births and Deaths Rules 2000 g izekf*kr fd k tkrk gS fd fuEu fyf kr lwpuk e R q ds ewy vfHkys k ls yh xbZ gS tks fd LFkkuh ks k LFkkuh fudk --------------------------------------------------------- rglhy k. M---------------------------------------------------------------------------- ftyk ---------------------------------------------------------------------------------------jkT -- la k jkT ks k --------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of death which is the register for local area / local body. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. e R q dh frfFk Date of Death. e R q LFkku Place of death. ekrk dk uke Name of mother. firk ifr dk uke Name of Father/Husband. e rd dk e R q ds le dk irk e rd dk LFkk h irk Address of the deceased at the time of death Permanent address of the deceased. jftLV hdj. k la-- Registration No. jftLV hdj. k dh rkjh k Date of Registration. fVIi. kh Remarks if any. tkjh djus dh rkjh k Date of issue. tkjh djus okys izkf/kdkjh ds gLrk kj Signature of the issuing authority tkjh djus okys izkf/kdkjh dk irk Address of the issuing authority eqgj Seal. M---------------------------------------------------------------------------- ftyk ---------------------------------------------------------------------------------------jkT -- la k jkT ks k --------------------------------------------------------------dk jftLVj gSA This is to certify that the following information has been taken from the original record of death which is the register for local area / local body. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. e R q dh frfFk Date of Death. of tahsil / block. of District of state / Union territory uke Name. fyax Sex. e R q dh frfFk Date of Death. e R q LFkku Place of death. ekrk dk uke Name of mother. firk ifr dk uke Name of Father/Husband. e rd dk e R q ds le dk irk e rd dk LFkk h irk Address of the deceased at the time of death Permanent address of the deceased. .

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