SARAL Print

State *

Hospital *

Government Name *

सरकार का नाम *

Top Left No. in Local Language *

Top Right No. in Local Language *

Department Name *

विभाग का नाम *

Hospital Name *

अस्पताल का नाम *

Death Certificate in Local Language - मृत्यु प्रमाण पत्र - स्थानीय भाषा मे *

लाइन नंबर 1 *

Line no. 1 *

लाइन नंबर 2 *

Line no. 2 *

Name in Local Language *

Gender in Local Language *

Date Of Death in Local Language *

Place Of Death in Local Language *

Mother Name in Local Language *

Father Name in Local Language *

ADDRESS OF DECEASED THE TIME OF Death [ Local Language ] *

PERMANENT ADDRESS OF DECEASED *

NAME OF HUSBAND / WIFE [ Local ] *

HUSBAND / WIFE AADHAAR NO [ Local ] *

AGE OF DECEASED [ LOCAL ] *

REGISTRATION NUMBER in Local Language *

DATE OF REGISTRATION in Local Language *

Remarks in Local Language *

DATE OF Issue in Local Language *

ISSUING AUTHORITY in Local Language *

Registrar in Local Language *

Registrar *

Hospital Stamp in Local Language *

Hospital Name as on Stamp *

Aadhar Number in Local Language *

Last Line in Local Language *

State Logo *

Form Logo *

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Add Stamp

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