TNAG-2319-FCO40-3363-Petitions-from-members-of-the-public-regarding-Hong-Kong-1991 — Page 29

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