Date :____________This is to certify that Shri/Ku. ________________________________ the bonafide students of our Institution. His/Her conduct is good in this Institution. His/Her College Roll No. ____________. He/She is studying in B.H.M.S. 1st. /2nd /3rd /4th Year during academic session ____________.
This is to certify that ____________________________ son of _____________________
Residence of ___________________________________ Age ___________ Sex __________Expired on
Date of Admission : ________________
Date of Death : ________________
Time of Death : ________________
Diagnosis : ________________
Immediate : ________________
Date : _____________Time : ____________
Medical Officer / Incharge
I Certify that the above information furnished by Pandit Jawaharlal Nehru Memorial Institute of
Homoeopathic Medical Sciences, Badndera Road, Amravati College has been verified by
_____________________________________(name ) University and the same is found correct.
Registrar of affiliating University with seal.