Directorate of Urban Local Bodies
ISSUANCE OF DEATH CERTIFICATE  - APPLICATION FORM
 [Note: Fields marked * are mandatory] Hindi Typing Instructions
Registration  Details:
Registration Id: Date of Registration:
Place of Death:
*District *Tehsil  
*Rural/Urban:
*
 
*Registration Unit
 
*Select Hospital/Home:    
                
Death Details:
 *Date of Death(dd/mm/yyyy) :
OR Year of Death
*Age of the Deceased:
 
*Gender of the Deceased:  
 * नाम (हिंदी):   Name of the Deceased (English):
 पिता का नाम (हिंदी):  Name of the Father/Husband(English):
Address:  
 *घर का नाम/नंबर (हिंदी): House Name/No.: (English)
 *लैंडमार्क / लोकैलिटी / कालोनी (हिंदी): Landmark/Locality/Colony: (English)
 पिन कोड:
Applicant Details:
*Applicant's Name: *Address:
*Mobile No: +91 *Email Id:
*Attach File(Only pdf):    
 
   
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