APPENDIX B
1
R.G. 721(S.)
6670018
200x100-6/71-885167
REGISTRAR GENERAL'S DEPARTMENT
HONG KONG
香港註冊 册總
總署
Entry No. 43.1.7.3.
IE NA Q
BIRTHS AND DEATHS REGISTRATION ORDINANCE, SECTION 17(2)
生死註册案例第十七欸第二段
FORM 12
十二號表格
CERTIFICATE OF REGISTRATION OF DEATH
死亡註冊證帶
Lau
Name of deceased person
死者姓名
Yick..you..
M
Sex
性別
Age
年龄
Date of death
死亡日期
Date registered
注册日期
Z.Z..
4873
گی
5 97.3.
Address at death 9
Wing.
Sised 8.4.
死亡地址
Signature of registrar
注册官簽名
This certificate must be produced on demand by a police officer to prove that
the name of the person entered has been registered.
此證否如遇警弁索須交出察看以証明上開之人名經已註册
NO FEE IS PAYABLE FOR THIS CERTIFICATE
頒此證書 無須繳費