Example of DEATH CERTIFICATE from the Government of the People’s Republic of Bangladesh

Government of the People’s Republic of Bangladesh

National heart disease institute & Hospital

Sere Bangla Nagar, Dhaka

DEATH CERTIFICATE 

This is to certify that Nayeb Ali, Age-55, Male, Father’s Name: Late Mainuddin, Religion-Islam, Profession-Service, Date of admission- 26-07-93, Date of death & time: 26-07-93, at 6.10 A.M Cause of death: Acute left Verticular failure.

Signature Sd/Illegible 26/7/93

Name: (Dr. Musaddiq Hossain)

(Duty Physician)

NATIONAL HEART DISEASE INSTITUTE & HOSPITAL, DHAKA

Enlisted no. 14585

Name: Nayeb Ali, Age-55, Male, Father’s Name: Late Mainuddin, Nearest Relative- A.B.M Kamrul Ahsan, Address- 366/A, Lalkuti, Mirpur, Dhaka, Room No-CCU, Bad No.-F, Date of death & time: 26-07-93, at 6.10 A.M cause of death: Acute left Verticular failure. Date & time of above transfer from the Room: Received.

Signature of Receiver of the death body:  Sd/Illegible 26/07/93 Name & Address : A.B.M Kamrul Islam

Signature: Sd/Illegible 26/07/93 Name : Dr. Musaddiq Hossain (Duty Physician)