FORM NO. 2 DEATH REPORT DEATH REPORT Legal information Statistical Information This part to be added to the Death This part to be detached and Register sent for statistical processing To be filled 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) 3. Sex of the deceased: (Enter male or female do not use abbreviation) 4. 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.) 4a. Name of father I husband: 5. Place of death: (Tick the appropriate 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 / Name: Institution 2.House Address: Date signature or left thumb mark of the Informant 6.Informant's name: Address: (After completing all columns 1 to 17, informant will put date and signature here:) Date signature or left thumb mark of the Informant To be filled by the Registrar Registration No: Registration Date: Registration unit Town/Village: District: Remarks: (If any) Name and signature of Registrar
