CoCOnlineApps

Death Registration

Death Report

Application Details
Application Number Application Status Date of Application
Date of Death Category of Application Registration Number
Details of Death
Is it an unidentified body? Yes          No Deceased's Name* Gender*
Deceased's Name(In Malayalam)*
Father's Name* Husband's Name* Mother's Name*
Father's Name(In Malayalam)* Husband's Name(In Malayalam)* Mother's Name(In Malayalam)*
Deceased Age(In Years)* Deceased Age(In Months) Deceased Age(In Days)
Deceased Age(In Hours)
Place of Death
Place of Death* Place Name of Institution*
Address Line1* Address Line2* Address Line3
Address Line1(In Malayalam)* Address Line2(In Malayalam)* Address Line3(In Malayalam)
Country* State* District*
Pincode Circle Office*
Doctor's Name OP/IP Number
Address of the deceased at the time of Death
* Either House Name, Flat Name/Residence Association or Flat Number/Residence Association is mandatory.

House Name Flat Name/ Residence Association Flat number/Residence Association
House Name(In Malayalam) Flat Name/ Residence Association(In Malayalam) Flat number/Residence Association(In Malayalam)
Ward Number Building Number Street Name
Street Name(In Malayalam)
Country*
State
District
Locality Place PostOffice
Locality(In Malayalam) Place(In Malayalam) PostOffice(In Malayalam)
Pincode
Mode of Communication
Telephone Number*(Eg:04846618993) Mobile Number*(Eg:9495537231) Email Address*(Eg:abc@gmail.com)
Applicant Details
* Either House Name, Flat Name/Residence Association or Flat Number/Residence Association is mandatory.

Informant's Name
House Name Flat Name/ Residence Association Flat number/Residence Association
Ward Number Building Number Street Name
Country
State
District
Locality Place PostOffice
Pincode
Mode of Communication
Telephone Number*(Eg:04846618993) Mobile Number*(Eg:9495537231) Email Address*(Eg:abc@gmail.com)
Permanent address of deceased
Is it a Village or Town?* Permanent Address*
Permanent Address(In Malayalam)*
Country*
State
District
Pincode
Statistical Details
Religion* Religion(Others)* Occupation of the Deceased
Treatment received before Death Was the cause of Death Medically Certified? Cause of Death
Did the death occur while pregnant or within six weeks of delivery? *
Was the deceased a habitual smoker? For how many years?
Did the deceased habitually chew tobocco? For how many years?
Did the deceased habitually chew areca nut? For how many years?
Did the deceased habitually drink alcohol? For how many years?
Remittance Details
Fees to be Paid
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