Death Certificate

 

 

(PSBDR Form-6A)

People’s Republic of Bangladesh  Bangladesh  Office of the Registrar of Birth & Death Chandina Paurashava Chandina, Cumilla.

Death Certificate [Rule-12, Of Birth & Death Registration (Municipality) Rules, 2006] (Extract From Death Registration)

Register No.

6

7

1

Date of Registration: 12/09/2018  0

Death Register No :

Name:

0

5

Date of Issue: 12/09/2018 6

8

9

MANIRUL ISLAM 

Date of Birth: 10-09-1939  

Sex: Male 

Date of Death: 10-06-1986  

Tenth June Nineteen Hundred Eighty Six.

Place of Death: WARD

NO- 06, 

Cause of Death (As stated by the Informer): Father’s Name: Mother’s Name:

Heart Attack  

AKAMOTALI SARKER   AMENA KHATUN

Spouse Name: DELOWERA

AKTER  

Permanent Address  : VILL:

CHANDINA, P.O&P.S: CHANDINA, DIST: CUMILLA.

(Prepared by- Seal and Signature)

(Signature and Name of Registrar with Seal)

Seal of the Registrar’s Registrar’s Office  Office