MK WEB 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

Birth Certificate in Local Language - जन्म प्रमाण पत्र - स्थानीय भाषा मे

लाइन नंबर 1 Type Your STATE NAME Instead Of AAA [In Local Language]

Line no. 1 Type Your STATE NAME Instead Of AAA

लाइन नंबर 2 Type Your HOSPITAL NAME Instead Of AAA, TEHSIL⟺BBB, DISTRICT⟺CCC and STATE NAME⟺DDD [In Local Language]

Line no. 2 Type Your HOSPITAL NAME Instead Of AAA, TEHSIL⟺BBB, DISTRICT⟺CCC and STATE NAME⟺DDD

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 THE DECEASED AT THE TIME OF DEATH [ Local Language ]

AGE OF DECEASED [ LOCAL ]

PERMANENT ADDRESS OF DECEASED

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 (English) *

NAME OF HUSBAND / WIFE [ Local ]

HUSBAND / WIFE AADHAAR NO [ Local ]

Aadhar Number in Local Language

Last Line in Local Language

State Logo

Form Logo

Add Signature

Add Stamp

Create Death Certificate