मृत्यु पंजीकरण

Year : Registration No.* : Registration Date* :
Date of Death* : Book No.* :
Dead Person Name* : Sex* :  Male Female Other Husband/Father Name* :
Dead Person Age* : Death Place :
Permanent Address*:
Informer Name* : Informer Address* :
Residence Place:
District : State :
Religion : Dead Person Profession:
Medication Before Death:
Is Post Mortem Done for Reason of Death:  Yes No Father Qualification:
In Case of Female is Do death is During Labour or Abortion: Labour Abortion
Is Addicted to Smoking: Yes No
If Yes Years
Is Addicted to Tobacco: Yes No
If Yes Years
Is Addicted to Pan: Yes No

If Yes Years
Is Addicted to Alchohal: Yes No
If Yes Years