|
1. |
Serial
No. |
Date |
|
2. |
Name &
Surname of the Deceased and his/her
nationality |
|
|
3. |
Name
of Husband/Father/Mother |
|
4. |
Occupation/Profession of the
Deceased |
|
5. |
Address
of the Deceased |
|
6. |
Religion, Caste and Sex of the
Deceased |
|
7. |
Occupation/Profession of
Husband/Father/Mother |
|
8. |
Date,
time and cause of death |
|
9. |
Age of
the Deceased |
|
10. |
Name
and Address of the Person Making
Report |
|
11. |
Date of
Report |
|
Asstt.
Admin. Officer
Deputy
Director/Director |