Repealed in part by Bom. 2 of 1911

(See section 444) PARTICULARS TO BE SPECIFIED IN THE REGISTER OF DEATHS 2[MUMBAI MUNICIPAL CORPORATION] REPORT OF DEATH IN 3[BRIHAN MUMBAI] Central Registry District Registration No. Date of death Date of registry in District Office __________________________________________________________________________________ Serial No. (Ward .......................................................... District No. ...........................................................Section ............................................................. Street or Wadi .............................................................. Abode .............................................................................. (House No....................................................) Duration of residence in 4[Mumbai] Years ....................................................................................... Months .................................................... Days .................................................................................. If a new comer to 5[Mumbai] or lately arrived, wherefrom : Village .......................................................... Taluka .............................................................................. District .................................................................................................................................................... Full name (including surname) .................................................................................... Father’s name .......................................................................................................................................... Sex ......................................... Nationality ................................. Race .......................................... Caste .............................. Age : Years ....................................... Months ............................................. Days ................................... Hours ....................................... Still-born ........................................... Occupation or profession of deceased ................................................................................................... Occupation or profession of guardian ................................................................................................... Place of birth, if in 6[Mumbai] : District ............................................................................................... Street or Wadi . ................................................................. House No. .............................................. If out of 7[Mumbai] : Village. ................................... Taluka . ..................... District ...................... Country to which family belongs ........................................................................................................... Place of death .................................................................................................................................... Cause of death .................................................................................................................................... Approximate interval between onset and death (duration of disease). Years .............................. Months ............................ Days ......................... Hours ........................