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Death Registration Form
Field marked With
*
are Compulsory!
Death Person Name :
*
Father Name :
*
Gender :
*
Select
Male
Female
Address :
*
Date of Death :
*
Samagra ID Number :
*
Death Place :
*
Cremation Place :
Relation With Applicant :
*
Reason Of Death :
Age :
Residence :
Occupation :
Challan Number :
*
Challan Date :
*
Applicant Signature :
File Size Limit 50KB
Samshan ya Hospital Ki slip:
File Size Limit 250KB
Other Document :
File Size Limit 250KB
Other Document Name :