Know your acknowledgement/Certificate No

Deceased First Name (atleast 3 chars):*

Spouse First Name (atleast 3 chars):

Mother First Name (atleast 3 chars):

Father First Name (atleast 3 chars):

Mobile No (10 Digit)

Entry Date	Deceased's Name	Spouse's Name	Mother's Name	Father's Name	DOD	Place of Death	Acknowledgement No.	Certificate	Mobile	Current Status