Fiscal Year : {{deadPat.FiscalYearFormatted}} Certificate No : {{deadPat.CertificateNumber}}

Medical Certificate of Death

This is to certify that Mr. Mrs. Ms. {{deadPat.ShortName}}, son of Mr daughter of Mr {{deadPat.FatherName}} and Ms. {{deadPat.MotherName}} spouse of {{(deadPat.Sex && deadPat.Sex.toLowerCase() == 'male')?'Ms.':''}} {{(deadPat.Sex && deadPat.Sex.toLowerCase() == 'female')?'Mr.':''}} {{deadPat.SpouseOf}} as per hospital record resident of Country {{deadPat.Country}} district {{deadPat.CountrySubDivision}} village/{{GeneralFieldLabel.Municipality}} {{deadPat.Address}} and inpatient/Emergency number {{deadPat.VisitCode}} expired on BS {{deadPat.DeathDate | nepaliDate}} ( {{deadPat.DeathDate}} AD , YYYY/MM/DD) time {{deadPat.DeathTime}} (24 hours) at the age of {{deadPat.Age}}. His Her cause of death was {{deadPat.CauseOfDeath}}

Certified By

Signature : ______________________

Name : ______________________{{CertifiedSignatory.FullName}}

Designation :______________________ {{CertifiedSignatory.LongSignature}}

Hospital/Health Facility

Name: {{HospitalDetails.hospitalName}}

Address: {{HospitalDetails.address}}