(PSBDR Form-6A)

People’s Republic of Bangladesh

Office of the Registrar of Birth & Death
Chandina Paurashava
Chandina, Cumilla.

Death Certificate
[Rule-12, Of Birth & Death Registration (Municipality) Rules, 2006]
(Extract From Death Registration)

Register No. 6 7 1
Date of Registration: 12/09/2018 Date of Issue: 12/09/2018

Death Register No : 0 0 5 6 8 9

Name: MANIRUL ISLAM

Date of Birth: 10-09-1939

Date of Death: 10-06-1986 Sex: Male

Tenth June Nineteen Hundred Eighty Six.

Place of Death: WARD NO- 06,

Cause of Death (As stated by the Informer): Heart Attack

Father’s Name: AKAMOTALI SARKER

Mother’s Name: AMENA KHATUN

Spouse Name: DELOWERA AKTER

Permanent Address : VILL: CHANDINA, P.O&P.S: CHANDINA,

DIST: CUMILLA.

(Prepared by- Seal and Signature) (Signature and Name of Registrar with Seal)

Seal of the Registrar’s Office