Death Certificate

Form C

[Rule 4(4)]

Death Certificate


This particular form C is for the Death Certificate, wherein it certifies that a woman employed in a mine, whose particulars shall be duly furnished in the required spaces within the form. The form shall also mention the name of the mine or circus wherein she was employed and the date of her expiry and whether it was before, during or after confinement. The details are to also specify whether the child, survived or died as well.

This form is to be signed by the Medical officer or Medical Practitioner along with his designation.

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