APPENDIX B
t.
R.G. 721(S.)
6670018
200x100-6/71-B85167
REGISTRAR GENERAL'S DEPARTMENT
HONG KONG
香港註册總署
43./.3.3...
Entry No. 4
註冊號碼
BIRTHS AND DEATHS REGISTRATION ORDINANCE, SECTION 17(2)
生死註冊條例第十七欵第二段
FORM 12
十二號表格
CERTIFICATE OF REGISTRATION OF DEATH 死亡註冊證書
Name of deceased person
死者姓名
Lan... Mick you.
yil.....
M
Sex
性别
Age
Z.Z...
年齡
Date of death
4823
死亡日期
Date registered
註冊日期
5973
Address at death. No. 9 Wang Sed 8.4.
死亡地址
Signature of registrar
註册官簽名
(a
This certificate must be produced on demand by a police officer to prove that the name of the person entered has been registered.
此證書如遇警索閱須交出察看以証明上開之人名經已註冊
NO FEE IS PAYABLE FOR THIS CERTIFICATE 領此證書無須繳費
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