Regional Institute of Medical Sciences, Imphal - Online Application for Death Certificate

Personal Details

* Name of Deceased:

* Gender:

* Marital Status of Deceased:

* Aadhaar No. of Deceased:

* Date of Expiry:

Address Details

* Present Address of the Deceased at the time of expiry:

* Permanent Address:

Uploads

* Provisional Death Certificate issued by RIMS Hospital: (Max file size: 400kb)

* Aadhaar Card of the Deceased: (Max file size: 400kb)

Declaration

I declare that all the above given information is true to the best of my knowledge.

(please tick)

Note: To reduce pdf file size, click here