Example of DEATH CERTIFICATE

(TRANSLATED TRUE COPY)

Bangladesh form no. 807

DEATH CERTIFICATE

Name: SABEDA KHATUN

Husband Name : MD. ABUL HOSSAIN

Address : Permanent : Vill- Jagannath Para, P.O+P.S- Sherpur, Dist- Bogra, and present address : 24/9, (1^st floor), Block-F, Joint Quarter, BiJli Mohalla, Mohammadpur, Dhaka-1207.  

Age- 59 yeras, Male/Female : Female, Religion- Islam, Profession : Housewife.

Date of admission:  31^st December, 2004, Time- 09:40 AM

Date of death : 31^st  December, 2004, Time- 10:00 AM

Name decent/ Region of death: Cardio respiratory failure due to unstable angina.

       

Sd/Illegible Secretary Central Scholarship Managing Committee

Sd/Illegible Secretary District Scholarship Managing Committee

Hospital : SSMC & MH, Dhaka Date : 31-12-04	Signature: Sd/Illegible
	Resident physician/Asstt. Register Division: Sd/Illegible
B.G.P. 93/94-10049J-5,00,000 Copy, 1994

(TRANSLATED TRUE COPY)

Bangladesh form no. 804

DEATH CERTIFICATE

Name: A.K.M MURSHID ALAM CHOWDHURY

Male ......................................

Religion-Islam

Age- 55

Profession: Govt. Service 

Address: A-2/4 Bangladesh Bank Colony, Faridabad, Dhaka

Date of admission:  19/03/1992, Time- 01:50 (Night)

Date of death: 19/03/1992, Time- 02:20 (Night)

Name disease / Region of death: A.M.I asthenia & his & AV necessitation & L.V.F

N.I.C.D Hospital       

...................19.........                                                     Signature: Sd/Illegible 19/03/92

It is hereby received our death body Miron 19/03/92

(Effective Officer) Resident Physician

	Sd/Illegible 19/03/92 Head Physician Officer Bangladesh Bank, Dhaka
B.G.P. 89/10036J-3,50,000 Copy, 1989