(UPBDR Form- 6)
People's Republic of Bangladesh
Office of the Registrar, Birth and Death Registration
XXXXXX Union Parishad
XXXXXX, Jamalpur
Death certificate
[Rule-12, Birth and Death Registration (Union Parishad) Rules, 2006]
(Extracted from Death Register Book)
Register book No. | 1 |
Date of registration: 15-12-2020 Date of delivery: 15-12-2020
Death Registration No: | 2 | 0 | 2 | 0 | - | 9 | 1 | - | 5 | 2 | - | 0 | 0 | 0 | 2 | 3 | 4 |
Name: S. XXX XXXXXXX Rahman Gender: Male
Date of death: 06-12-2020
Six December Two Thousand and Twenty
Place of death: 264. Elephant Road, Dhaka
Cause of death (as per the description of the informant): Normal death.
Father's name: X. X. X. Karim
Mother's name: Late XXXX XXXXXX
Spouse's Name: XXXXXX Rahman
Permanent Address: 20001. Elephant Road, Post Office - New Market,
1205, Dhaka South City Corporation, Dhaka.
[Signature/ illegible] 15/12/2020 (UP Secretary - Signature and Seal) [Seal/ Md. XXX XXXX Secretary XXXXX Union Parishad No. 6 XXXXX, Jamalpur.] | [Stamp/ XXX Union Parishad No. 6 * XXXXX, Jamalpur *] | [Signature/ illegible] 15/12/2020 (Registrar's signature and seal with name) [Seal/ Md. XXXX XXXX Badal Chairman XXXXX Union Parishad No. 6 XXXX, Jamalpur.] |
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