GOVERNMENT OF MEGHALAYA

APPLICATION FORM FOR OBTAINING DEATH CERTIFICATE

Enclosures Required [ These enclosures are required depending upon place of death and after how many days the application is submitted]
Death in Hospital
1. Declaration of Death
2. Identity Proof of Deceased
Death at Home
1. Affidafit [If application submitted after 30 Days of demise]
2. Court Order on Death [If application submitted after 365 Days of demise]
3. All Documents submitted to Court [If application submitted after 365 Days of demise]
4. Form II
5. Headman Certificate
6.Form No 4A
7. Doctor's Certificate

Informant's Basic Details

Name of Informant *

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Mobile Number *

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E-Mail

Relationship with the deceased

Application Specific Details

Name of Deceased *

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Gender *

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Male

Female

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Father's Name *

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Mother's Name *

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Name of Spouse

Date of Death *

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Place of Death *

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Hospital Name *

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Application Submission Location *

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No of days after which death is reported *

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Address of the Deceased Person

District *

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Complete Address *

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Declaration

I declare that the statements made here is true to the best of my knowledge and belief and if anything is found untrue I shall be liable for a penalty as per law.

I Agree *