| 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 |
