Certificate Of Death/Incapacitation Of Military/Para Military Personnel
Certified that Mr./Ms.___________________, is the son/daughter/spouse of Shri _____________________ rank ______________________.
Shri _________________ was killed/incapacitated in action on ________________ (mention date), and his death/incapacitation did not occur due to an accident while performing a routine duty pertaining to job requirement.
| Date | Seal | Signature of Authorized Officer |