[117]

TAMIL NADU

GOVERNMENT GAZETTE

PUBLISHED BY AUTHORITY

No. 46]

CHENNAI, WEDNESDAY, NOVEMBER 13, 2019

Aippasi 27, Vikari, Thiruvalluvar Aandu–2050

©

[Regd. No. TN/CCN/467/2012-14

GOVERNMENT OF TAMIL NADU

[R. Dis. No. 197/2009.

2019

[Price : Rs. 1.60 Paise.

DTP—46-III-1(a)

Part III—Section 1(a)

General Statutory Rules, Notifi cations, Orders, Regulations, etc.,

issued by Secretariat Departments.

NOTIFICATIONS BY GOVERNMENT

CONTENTS

Pages.

HEALTH AND FAMILY WELFARE DEPARTMENT

Amendment to the Tamil Nadu Registration of Birth and Death Rules ..

..

..

118-119

118-119

118

TAMIL NADU GOVERNMENT GAZETTE

[Part III-Sec.1(a)

NOTIFICATIONS BY GOVERNMENT

HEALTH AND FAMILY WELFARE DEPARTMENT

Amendment to the Tamil Nadu Registration of Birth and Death Rules.

[G.O. Ms. No. 384, Health and Family Welfare (AB2), 27th August 2019, ÝõE 10, Mè£K, F¼õœÀõ˜ ݇´&2050.]

No. SRO A-42/2019.—In exercise of the powers conferred by sub-section (1) of Section 30 of the Registration of Births

and Deaths Act, 1969 (Central Act 18 of 1969), the Governor of Tamil Nadu hereby makes the following amendment to the

Tamil Nadu Registration of Birth and Death Rules, 2000 as subsequently amended.

Aඕඍඖඌඕඍඖග

In the said Rules, in the Annexure, for Form No. 2, the following Form shall be substituted, namely:-

FORM No. 2

[See rule 5(1)]

Death Report

Legal Information

This part to be added to the Death Register

Form No. 2

This part to be detached and sent for

statistical processing Death Report

(Statistical Information)

Form No. 2

To be fi lled by the informant

1.

Date of Death:__________________

(Enter the exact day, month and year the death took place) (e.g. 1.1.2000)

2.

Name of the Deceased:_____________________

(Full name as usually written)

UID No. of deceased (if any)

3.

Sex of the deceased: (Enter Male/Female/Transgender)

(do not use abbreviation)

4.

Name of the Mother:__________________________

UID No. of the Mother (if any)

5.

Name of the Father:__________________________

UID No. of Father (if any)

5(a) Name of Husband/Wife:__________________________

UID No. of Husband/Wife (if any)

5(b) Age of Husband/Wife:_____________________

5(c) Contact details of Husband/Wife: __________________

_______________________________________________________________

6.

Age of the deceased:___________________________

(If the deceased was over 1 year of age, give age in completed years. If the

deceased was below 1 year of age, give age in months, and if below 1 month give

age in completed number of days, and if below one day, in hours)

7.

Address of the deceased at the time of death:_____________________________

________________________________________________________________

8.

Permanent address of the deceased:____________________________________

________________________________________________________________

9.

Place of death:__________________________

(Tick the appropriate entry 1,2 or 3 below and give the name of the Hospital/

Institution or the address of the house where the death took place. If other place,

give location)

1. Hospital / Institution Name:__________________________________

________________________________________________________

2. House Address:____________________________________________

3. Other Place:______________________________________________

10. Informant's Name:_________________________________

Address:__________________________________________

(After completing all columns 1 to 21, informant will put date and signature here:)

Date:

Signature or left thumb mark of the informant

To be fi lled by the Informant

11. Town or Village of Residence of the

deceased:

(Place where the deceased actually

lived. This can be different from the

place where the death occurred. The

house address is not required to be

entered.

a)

Name of Town/Village:

b)

Is it a town or Village:

tick the appropriate entry below)

1.

Town

2. Village

c)

Name of District:

d)

Name of State:

12. Religion (Tick the appropriate entry

below)

1. Hindu 2. Muslim 3. Christian

4. Any other religion: (write the name

of the religion)

13. Occupation of the deceased:

(If no occupation write ‘Nil’)

14. Type of medical attention received

before death: (Tick the appropriate

entry below)

1.

Institutional

2.

Medical attention other

than institution

3.

No Medical attention

To be fi lled by the informant

15. Was the cause of death medically

certifi ed?

(Tick the appropriate entry below)

1. Yes 2. No.

16. Name of Disease or Actual Cause of

Death:

(for all deaths irrespective of whether

medically certifi ed or not)

17. In case this is a female death, did

the death occur while pregnant, at

the time of delivery or within 6 weeks

after end of pregnancy:

(Tick the appropriate entry below)

1. Yes 2. No

18. If used to habitually smoke for how

many years?

19. If used to habitually chew tobacco in

any form -

For how many years?

20. If used to habitually chew arecanut

in any form (including pan masala)

For how many years?

21. If used to habitually drink alcohol for

how many years?

(Column to be fi lled are over, Now put

signature at left)

To be fi lled by the Registrar

Registration No:

Registration Date:

Registration Unit:

District:

Town / Village:

Remarks ( if any)

Name and Signature of the Registrar

To be fi lled by

Name: Code No.

District:

Taluk:

Town/Village:

Registration Unit:

the Registrar

Registration No: Registration Date:

Date of Death:

Sex: 1. Male 2. Female 3. Transgender

Age: Years/months/days/hours

Place of Death: 1. Hospital/Institution

2. House 3. Other place

Name and Signature of the Registrar

Form No. 2

Nov. 13, 2019]

TAMIL NADU GOVERNMENT GAZETTE

119

PRINTED AND PUBLISHED BY THE DIRECTOR OF STATIONERY AND PRINTING, CHENNAI

ON BEHALF OF THE GOVERNMENT OF TAMIL NADU

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BEELA RAJESH,

Secretary to Government.