FROM-6 GOVERNMENT OF ASSAM DEPARTMENT OF HEALTH SERVICES HARINA NEW PRIMARY HEALTH CENTRE DEATH CERTIFICATE (ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT. 1969AND RULE 8/13 OF THE ASSAM REGISTRATION OF BIRTHS 7 DEATHS RULES 1999) THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR HARINA NEW PRIMARY HEALTH CENTRE OF TAHSIL/BLOCK SONAI OF DISTRICT CACHAR OF STATE/UNION TERRITORY ASSAM INDIA. NAME OF DECEASED : HASINA BEGUM LASKAR SEX: FEMALE DATE OF DEATH PLACE OF DEATH: 23-09-2021 BAGPUR PT III P.O. BAGPUR TWENTY THREE SEPTEMBER TWO CACHAR, ASSAM - 788101 THOUSAND TWENTY ONE AGE OF DECEASED: NAME OF HUSBAND/WIFE: 28 YEARS RAHIM UDDIN LASKAR HUSBAND /WIFE AADHAR NO: NAME OF MOTHER: NAME OF FATHER: MOTHER’S AADHAR NO: FATHER’S AADHAR NO: ADDRESS OF THE SECEASED AT THE TIME OF DEATH PERMANENT ADDRESS OF DECEASED: BAGPUR PT III P.O. BAGPUR BAGPUR PT III P.O. BAGPUR CACHAR, ASSAM - 788101 CACHAR, ASSAM - 788101 REGISTRATION NO: DATE OF REGISRTAION: D:2022 18-12394-556819 17-08-2022 REMARKS (IF ANY): --- DATE OF ISSUE: ISSUING AUTHORITY 27-08-2022 REGISTRAR (BIRTH & DEATH) HARINA NEW PRIMARY HEALTH CENTRE UPDATED ON: 27-08-2022 20:56:14 “THIS IS A COMPUTER GENERATED CERTIFICATE” THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27 JULY-2015 HAS APPROVED THIS CERTIFICATE AS A VALID LEGAL DOCUMENT FOR ALL OFFICIAL PURPOSES. “ENSURE REGISTRATION OF EVERY BIRTH AND DEATH”