An Example of Death Information

Kingdom of Saudi Arabia

Ministry of Municipal & Rural Affairs

Secretariat of Riyadh City

General Deptt. of Environment Health

Department of Equipping

Information about the Deceased

Name of the Deceased: MOHD. KABIR YOUNUS ALI,  

Nationality – Bangladeshi

Sex: Male,   Age – 46 Years     Date of Burial : 5/12/1424H.  Time: 4 P.M

Cause of Death: Traffic Accident          Date of Death: 27/11/1424H.

Place of Death: Riyadh Medical Complex

Identity No.  2140154804, Date: 24/8/1421H. Place of Issue: Riyadh

Name of the Reporter: Sirajul Islam Adel     Nationality- Bangladeshi

Identity No.  2064548833, Date – 25/1/1420H.  Place of Issue: Riyadh

Relation : Cousin         Address: Riyadh, 4588722

                                                                  Mob: 052809478

Declaration

I, the above  named & Identity holder reporter do hereby declare that the above mentioned information about the aforesaid deceased is correct and on my personal responsibility and given sign.

Name: Sirajul Islam Adel

Sd/- Illegible                                  Supervisor of  South Riyadh Graveyard

                                                       Name: Mohammed Ali Jowhar

                                                       Sd/- Illegible