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DEATH CERTItrICATE

IFI/Nme............

lItrfi 6'I 3IIEIR t,/UrDNo. ofd*6ed E

ftitr,zS"*

......... T.g d frfu/Oate orosrh(oi6'f t/tn Numb*1............._1

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ft6 61 qq7N*"ofFarher..-..............

fuof Of silqt{ i./utDNo.ofFa$s

qfrZcfu 6I ;IFt/NmeofHEb.Ailife.....................................qft2qfu an snsR i.,/uDr".

qfrZcfr A iilrg/AgeofHub. Ailife........... cfr/c'ffr or qqd ftflq./contacrD€h*orHur.firf1ll

CTB-6-df d Efifsr/

Signature of Receiver..............................

lltqfiF-df Or iIrI 4 \i|I/Receivu,sName &add..

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d qI6T HRf, Eftrq-{/ sigmhre of the issuing

authority with Seal

'frd-o uq G Tq a.r qfr6-{ur EF{Rqf, 6i."/"Fnsure registration of every birthand death*

EdT

sfiRftc qqr{ cre.e. qfoq.

Atal Nagar, the l3th September 2021

NOTIFICATION

F. No. 04-04 l2lllt23.-ln exercise of the powers conferred by clause (a) of sub-section (2) of Section

30 of the Registration of Births and Deattrs Ac! 1969 (No. 18 of 1969), the State government, hereby, makes the

following amendment in Chhattisgarh Registration of Births nnd Deaths Rules, 2001, namely:-

AMENDMENT

ln Form of the said rules,-

l. For Form No.2, the following shall be substituted, namely:-

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orm No. 6, the following shall be substituted, namely :

Str Ti. /Book No. 20....t.........

srEiFrliiF/Sl. No.

ffit7sex.......................................,..T.C o1 ffi,ro"t"'"io*rli".*., ti,rir-i",.ff]l_ _fL-

'iq #;;;;;;;;;

TkII S-f lFI/Nre of Mothcr.................

qrAf Or en ri i./uro r.to. oruotra

fuer ot qfq/Nm. of Father................................................. fril or uun t 7grr" "a""**

B/q.fr 6I rIFIlNueofHub./Wife.....................................oft2ot

6r srErR q./umNo.

qff'oqq{EqTZ RegistratimNo.

. qifr6er'ft+7;";";#;;;.

gf!ilft-df d EfrETt/ Signatue of Receiver................._............

qfsm-di ST ;lIE 4 rlflI/Receiver,s Name & add..

lQ/trg iilrglAseorHusb.^ilire.. .. .... vfr/vh 6r q,qd fr"*.i;":;;;;";;;.0.#

crEo'rt d fd-r {R-d Eftrert,/u1,f,:H;:fr.;".i-*

,/"Ensure registration of weVbirth and death"

'q-.tfi vq cq f.g o.r qfrs-tor Ef{R-qil 6t,.

{ara-*, gror au tqc sr{ff , 6fl srs enr vwff q Upn-m, rmgr i gFa aw *nRa - z o z r.