Example of DEATH CERTIFICATE from SWADESH CLINIC

      SWADESH CLINIC

South Jatrabari (Dolarpar)

Dhaka-1204, Bangladesh

SI. No. 103                                                                                         Date :

 

DEATH CERTIFICATE

Date of Death			: 25 April 2004				Time		11-30 A.M
Name of Deceased Person						: Mofizur Rahman	Sex		Male
Cause of Death			: Over bleeding and serious injury on head which caused heart failure
Place of Birth :			SWADESH CLINIC
			South Jatrabari (Dolarpar) Dhaka-1204, Bangladesh
Mothers Name			: Mrs. Shahinur Begum					Age		16-01-1953
Fathers Name			: Abdur Rob Howladar
Religion	: Islam (Sunni)
Present Address				: Village- Pagla, Post Office- Fatullah, Police Station- Fatullah
				District- Narayangonj.
Permanent Address					: Village- Rahimgonj, Post Office- Brammondia, Police Station-
					Babugonj, District- Barisal
Duty Officer			: Abu Hyder Chowdhury

Signature

Medical Officer

SWADESH CLINIC