Legal Information

Form - 2 DEATH REPORT (Rule 5)
Form - 8 DEATH REGISTER (Rule - 13)
Legal Information
(This part to be added to the Death Register)
1. Date of Death (Day, month & year to be written)* :
2. Full Name of the Deceased* :
3. Sex of the Deceased (Enter Male or Female)* :
4. Age* :
5.(a) Permanent Address of the deceased* :
(b) Address of the deceased at the time of death* :
(c) Name of the Father/Husband of the deceased* :
(d) Mother's name of the deceased* :
6.(a) Place of Death* :
(b) Address of place of Death* :
Doctor's Name* :
Doctor's Registration No.* :
7.(a) Informant's Name* :
(b) Informant's Address* :
(c) Informant's Email *:

Statistical Information

Form - 2 DEATH REPORT (Rule 5)
Statistical Information
(This part to be detached and sent for statistical processing)
8. Town or village of Residence of the Deceased* :
(Place where Deceased actually lives. This can be different from the place where the death occured. The House address is not required to be entered.)
(a) Name of the Town/Village* :
(b) Name of District* :
(c) Name of the State* :
(d) PinCode of the Town/Village* :
9. Religion* :  
10. Occupation of Deceased (if no occuption write 'Nil')* :
11. Type of medical attention received before death* :
12. Was the cause of death medically certified* :
13. Name of Disease or Actual Cause of Death* :
14. In case this is a female death, did the death occur while pregnant, at the time of delivery or within 6 weeks after the end of pregnancy :
15. If used to habitually smoke, for how many years ?
16. If used to habitually chew tobacco in any form - for how many years ?
17. If used to habitually chew areca in any form (including panmasala) for how many years ?
18. If used to habitually drink alcohol for how many years ?
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Source: New Town Kolkata, Development Authority West Bengal   |   Last Updated on: 20/09/2018|   You are visitor counter

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