Embassy of the People's Republic of Bangladesh

Stockholm

Anderstorpsvägen 12, 1 Tr.

171 54 Solna, Sweden
Phone: + 46 8 730 5850, Fax: + 46 8 730 5870
E: consular@bangladeshembassy.se, W: www.bangladoot.se
Death Certificate Form

1. Name of the deceased person in full (block letters):

_____________________________________

2. Father’s name Mother’s Name Spouse’s name

_____________________ _____________________ ______________________
3. Passport No.: _____________________ 4. Nationality (Present):
_______________________

5. Sex: Male Female

6. Date of birth: _______________________ 7. Place of birth (district): ____________________
8. Date of death________________________ 9. Place of death ____________________________
10. Cause of death__________________________________________________________________
11. Present Address: ________________________________________________________________
_______________________________________________________________________________
12. Address in Bangladesh:___________________________________________________________
______________________________________________________________________________
13. Name of the custodian / informant / applicant of the deceased in the foreign country:
______________________________________________________________________________
_______________________________________________________________________________
Telephone: _____________________________ Email: ______________________________
14. Particulars of the next of kin in Bangladesh to receive the dead body:
(a) Name:_______________________________________________________________________
(b) Telephone: ___________________________ Email (if any):___________________________
(c) National ID Number: __________________________________________________________

I do hereby enclose the following:

 Death Certificate from the hospital
 Photocopy of the passport of the deceased
 ID of the next of kin/relative/custodian of the deceased in the foreign country
 Also confirming that the above information are true and no death certificate was issued for
the above person before.

Signature of the applicant: _________________________ Date: __________________________