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ANNEXURE VIII

                                                      ............................ Town Panchayat             Here affix
                                                                                                                        Court fee
                                                                                                                        Stamp for
                                                                                                                        Rs.2/-

 FORM OF APPLICATION FOR ISSUE OF DEATH CERTIFICATE

 From

Thiru/Tmt.

  To

The Executive Officer,

......................Town Panchayat

 Sir,

                             Sub:- Application for death certificate     

                                                          ---

           I request that ..... copy/copies of Death  Certificate, the details of which are given below, may be issued.

 1. Name of the deceased

 2. Age of deceased and sex
    (Male/Female) 

3. Name of the Father/Husband
   of the deceased 

4. Place of death, Hospital/
   House (with details) 

5. Date of death 

6. Purpose for which this
   Certificate is required 

7. Relationship of the
   applicant with the
   deceased 

8. Particulars of remittance
   of fees:                                        Amount Rs.

                                                     Receipt No..... Date...

 Place:

Date:

                                                                                              Signature of Applicant        

ACKNOWLEDGEMENT

                                     The  application for death  certificate  from Thiru................... has been received on ......... in   thisoffice.   He  is  informed  to  contact  the  Executive   Officer regarding  this application on .......... (after 10  days).   His application  has  been registered as Sl.No..... in  the  register maintained for this purpose.

                                                                                                                                                                                             Executive Officer,
                                                              ............... Town Panchayat.

                                         


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 Last  updated on Friday, May 30, 2008