मांक 1 No. 1 महारा शासन फॉम-6 GOVERNMENT OF MAHARASHTRA FORM-6 आरोय वभाग DEPARTMENT OF HEALTH MUNICIPAL CORPORATION NASHIK WEST ZONE मृयु माण-प DEATH CERTIFICATE जम व मृयु नदणी अधनयम, 1969 या कलम 12/17 आिण महारा जम आिण मृयु नदणी नयम, 2000 चे नयम 8/13 अवये देयात आले आहे. (ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MAHARASHTRA REGISTRATION OF BIRTHS & DEATHS RULES 2000.) मािणत करयात येत आहे क, खालल माहती मृयुया मूळ अभलेखया नदवहतून , तालुका नाशक , िजहा नाशक , राया या नदवहत उलेख आहे. THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR MUNICIPAL CORPORATION NASHIK WEST ZONE OF TAHSIL/BLOCK NASHIK OF DISTRICT NASHIK OF STATE/UNION TERRITORY MAHARASHTRA, INDIA. मृताचे नाव / NAME OF DECEASED : अजय आबाजी चहाण / AJAY ABAJI CHAVHAN लंग / SEX: पुरष / MALE मृयू दनांक / DATE OF DEATH: मृयू ठकाण / PLACE OF DEATH: 02-12-2018 सिहल हॉिपटल नाशक पिम /CIVIL HOSPITAL NASHIK WEST SECOND-DECEMBER-TWO THOUSAND EIGHTEEN पती / पी माहती नाव / NAME OF HUSBAND / WIFE: मृत यचे वय / AGE OF DECEASED: 48 YEARS आधार मांक / HUSBAND/WIFE UID NO. : --- आईचे पूण नाव / NAME OF MOTHER: वडलांचे पूण नाव / NAME OF FATHER : केशरबाई आबाजी चहाण / KESHARBAI ABAJI CHAVHAN आबाजी बळीराम चहाण / ABAJI BALIRAM CHAVHAN आधार मांक / MOTHER'S UID NO. : --- आधार मांक / FATHER'S UID NO. : --- मयत यीचा मृयूसमयीचा पा / ADDRESS OF THE DECEASED AT THE TIME OF DEATH : मयत यीचा कामयचा पा / PERMANENT ADDRESS OF DECEASED : FLAT NO 13 , NIRMAN VIHAR VISE MALA , NEAR MALPANI HOSPITAL , COLEGE ROAD , NASHIK, NASHIK, NASHIK, MAHARASHTRA- 422005 FLAT NO 13, NIRMAN VIHAR VISE MALA, NEAR MALPANI HOSPITAL, COLEGE ROAD, लॅट न १३ , नमाण वहार वसे मळा , मालपाणी हॉिपटल शेजार , NASHIK, NASHIK, NASHIK, MAHARASHTRA- 422005 कॉलेज रोड , नाशक (म कॉप.), नाशक, नाशक, महारा- 422005 लॅट न १३ , नमाण वहार वसे मळा , मालपाणी हॉिपटल शेजार , कॉलेज रोड , नाशक (म कॉप.), नाशक, नाशक, महारा- 422005 नदणी मांक / REGISTRATION NO: नदणी ​दनांक / DATE OF REGISTRATION: D-2018: 27-90330-005834 12-12-2018 शेरा / REMARKS (IF ANY): --- माणप दयाचा दनांक / DATE OF ISSUE: नगमत करणारे ाधकार / ISSUING AUTHORITY 12-12-2018 उप-रिजार (जम व मृयु) SUB-REGISTRAR (BIRTH & DEATH) MUNICIPAL CORPORATION NASHIK WEST ZONE UPDATED ON : 2018-12-12 "THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY" THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS APPROVED THIS CERTIFICATE AS A VALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES. " येक जम आिण मृयूची घटना नदयाची खाी करा " / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH " rmITmJfH;5i!i:_WMHi~wR_C"w**jr%¥ii'fgi¢heSHS"Hm . a flI'1fi1~IHQI 3~ IT"~.) I/ " ~. I. ICI;fdl1_4q; ~ ~ d Vlfil4hu6io (~ ~'i ~ff~l 3Tf~ 'I ~ 'I~ ~) \R:IT ~ \ifI:fr.:r 3-TTtr<'11 fcl~~ I' 1'*]9 ~4\~\ 'SfS"\'q ~~ ~ ~ ~ ~cll1JT~ ~ ~ ~ mf::rJl ~l"\","",,~ \ J>(G{'t\ ~OnQ~ i.gwy ~ ~ ~~lfaM("Rt I f'I"i>mfl ~". m. 1'1<:4?iiiZll ~ ~ ~~ ;,mt<;. «IT ~ W.;IT q;:''IT~I' 'f I ~ ~ 3ffwm-..:ft ~ ~ ~./~ Cf>1'1<4?1 ~ w~ ';f~ ~ f.1clm;ft ~ Wf 3~. 'ffifu!r lfft-;r ~ rn rn I ~ i 0 ; 'I ~cflCfil(oiI""'Ilift ~ 'E'nOIl""'lI.:fl ~ fd141101~ ~ fli05q)81=a ~/9 ~ 3<'1I'<'1ld{)(,,! ~ qI ey"1 'C) mRm (f,f aRM fc.~ :mg. CR ~ ~ ~ 411\"%ffi ~ ~, ~ fI(q~dld<'1 m~ ~ 3f¥, zmorm ~ mt ~ ~ m~ ~~ 9<:~o ~ 'Cf)'fflf 9Q,~ (~), 9~~,~OO ~ C1'<(jcn1f11{ ~-m d5(qa~,< d51'ffc1 104 .' .' ] ( 29508 ( 37101 ( 37101 ( 3710J ( 37101 ,,,,, 3.20.00112.00 iSlldlilki - <'1i'r ~ sar 0.00.00 (7881),( 15783),( 19732),(21575),(21821),(34481) 1TIcf :- JOt<&JOt('IICIIIe; 't)"qc-qr~~: 37101 cr~: 18/03/2019 .ffiiil ~ i4)~.... Iifp:/~9~ 16.s~ .lie e([a12beta_testlPgHtmI712.aspx 3/1 9/201 9 :J A~ 2"9