Form No. 2 1 Date of Death - - 2(d) Address of Deceased at the time of Death 3 Sex of the Deceased M - Male F - Female 4 Age of Deceased Year Month Days Hours 6 Informant's Name & Address Date of Death Signature or left thumb mark of the informant Registration No. Registration Date - - Date of Death - - Town / Village District Remarks (if any) 2 (c) Permanent Address of Deceased To be filled by the informant(in Capital Letter only) 2 Name of the deceased (Full Name as usually written) 2(a) Name of the father / Husband of Deceased 2(b) Name of the Mother of Deceased DEATH REPORT GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI Legal Information This part to be added to the Death Register 1 Hospital / Institutional 2 House (if the deceased was 1 year of age, give age in complete years, if the deceased was below 1 year of age give age in months, if below 1 month give age in complete number of days and if below 1 day in hours) 5 Place of death (Tick the appropriate entry) 3 Other Place (After completing all columns 1 to 17 informant will put date and signature here) Name & Signature of the Registrar and Stamp (To be filled by the Registrar) Form No. 2 7 Town or Village of Residence of the deceased a Name of Town / Village 1 Town 2 Village c Name of the District d Name of State 8 Religion 9 Occupation of the deceased 1 Hindu 2 Muslim 3 Christian 4 Other, if any 10 Type of Medical attention received before death 1 Institutional 2 Medical attention other than institution 3 No medical attention 11 Was the cause of death medically certified Yes No 12 Name of Disease or Actual cause of death Yes No after the end of deliver y 14 if used to habitually smoke for how many years? Name of the District Tehsil Code No. Town / Village Registration Unit Code No. Registration No. Registration Date - - Date of Death - - Sex M - Male F - Female Year Month Day Hours Ag e Place of Death 1. Hospital / Institution 2. House 3. Other Place Name & Signature of the Registrar and Stamp GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI DEATH REPORT Statistical Information This part to be detected and sent for statistical processing To be filled by the informant(in Capital Letter only) b Is it a town or village? (Tick the appropriate entry below) Code No. 13 In case this is a female death did the death occur while at the time of delivery or within 6 week 15 if used to habitually chew tobacco in any form for how many years? 16 if used to habitually chew arecaunt in any form for how many years? 17 if used to habitually drink alochol for how many years? Code No. (To be filled by the Registrar)
