ANNEXURE 7

(Section 13 of Act No. 68 of 1997: Regulation 7)

DEATH CERTIFICATE

PARTICULARS FROM THE POPULATION REGISTER IN RESPECT OF :

IDENTITY NUMBER:        ..............................................................................

SURNAME:                ..............................................................................

FIRST NAMES:                ..............................................................................

DATE OF BIRTH:                ..............................................................................

GENDER:                ..............................................................................

MARITAL STATUS:        ..............................................................................

DATE OF DEATH:        ..............................................................................

PLACE OF DEATH:        ..............................................................................

CAUSE OF DEATH:        ..............................................................................

DATE ISSUED:                ..............................................................................

OFFICE CODE/STAMP:        ..............................................................................