Form No. 8
Annexure
Form VIII
 
MORMUGAO MUNICIPAL COUNCIL
   
DEATH REPORT
Legal Information
This part to be added to the Death Register
 
To be filled by the informant

1. Date of Birth : (Enter the exact day, .....................................................................................
month and year the death took place (e.g. 1-1-2000)
   
2. Name of the deceased : ....................................................................................................
(Full name as usually written)
   
3. Sex of the deceased : .......................................................................................................
(Enter "Male or female",do not use abbreviation)
   
4.
Age of the deceased (if the deceased was over 1 year of age, give ........................................
age in completed years, If the deceased was below 1 year of age, give age in months
and if below 1 month give in completed number of days, and if below one day, in hours.)
   
5. Place of death : (Tick the appropriate entry 1,2 or 3 below and give ........................................
the name of the Hospital/Institution or the address of the house where
the death took place. If other place, give location)
   
  1. Hospital/Institution Name : ............................................................................................
  2. House Address : ............................................................................................................
  3. Other place : ................................ ................................................................................
   
6. Name of the father/husband : ...........................................................................................
   
7. Informant's name : ...........................................................................................................
Address : ...........................................................................................................................
(After completing all columns 1 to 17, informant will put date and signature here:)
   
   
  Date:                                              Signature or left thumb mark of the informant

                                To be filled by the Registrar
   
   Registration No. :    Registration Date:
   Registration Unit :  
   Town/Village :    District :
   Remarks : (If any)  
   
   
Name and Signature of the Registrar

Click here to fill in the Statistical Information in Death Report

 

Back to 'Certificate of Birth/Death'