Example of EXTRACT FROM THE REGISTER OF THE DEATH

(Monogram)

DHAKA CITY CORPORATION

Bangladesh Court Fee One Taka

Dhaka, Bangladesh.

Health Division

SCHEDULE D

EXTRACT FROM THE REGISTER OF THE DEATH

(RULE 21 OF 1879)

1.       Serial No.                        :                          Date of Issue: 15 Jan. 2005

2.       No. in Register                : 61470

3.       When died                      : 22/06/98

4.       a) Nationality                   : Bangladeshi      b) Religion: Islam

5.       Name of deceased                    : Md. Golam Sarowar Chowdhury

6.       Name of father                : Late Joynal Abedin

7.       a) Age – 50 years     b) Male        c) Profession

8.       Cause of death      : Stock

9.       Place of death        : 35, K. B. Rudra Road, Chandighat, Dhaka.

10.                                     Residence previous to last illness :  x

11.                                     Name and address of reporter of death: Golam Haider Chowdhury

12.                                     When registered     : 22/06/98

13.                                     Remarks (if any)    : Death Register Book No. 32. 2. 6.98. – 18-7. 98.

14.                                     Signature of the officer in charge of the Register

	Sd/- Illegible Certified true extract
Prepeared by: Name: Abu Jafar Md. Elias                            Sd/- Illegible                                  15/01/05 A.                                                                                          Z. Elias                             Record Keeper                       Birth & Health (H.D)                     Dhaka City Corporation	Sd/- Illegible Chief Health Officer Dhaka City Corporation, Dhaka, Bangladesh.
Compared by: Name: Akhter Hossain                                 Sd/- Illegible                                      15/01/05                          Food & Sanitation Officer                       Dhaka City Corporation.