THE HONGKONG GOVERNMENT GAZETTE, 29TH AUGUST, 1896.
(Q.)
BIRTHS AND DEATHS REGISTRATION ORDINANCE, 1896.
MEDICAL CERTIFICATE OF THE CAUSE OF DEATH
day of death was as hereunder written. on the during the last illness; that such Person's age was stated to be died * To be given by the Medical Attendant to the Person whose duty it is to give it, with information of the Death, to the Registrar General or a Registrar of Deaths and TO NO OTHER PERSON. that and that to the best of my knowledge and belief the Cause of h day of
on the
I HEREBY CERTIFY that I attended
that I last saw h
st
Should the Medical Attendant not feel justi- fed in taking upon himself the responsibility of cer- tifying the fact of Death, he may here insert the words “as I am informed.”
† The duration of cach form of Disease or Symp- tom is reckoned from its commencement until death occurs.
Primary, ..................
Secondary,
18
Cause of Death.
Duration of Disease in
RI
Years. Months.
Days.
Hours.t
No. of corresponding Entry in Register Book
to be inserted
here by the Registrar: of Deaths to
[The Informant should read the
Notice on the back
of this Form.]
Witness my hand, this
day of
18
Signature ...................................... Registered qualification. Residence...........................................................**
N.B.-This Certificate is intended solely for the use of the Registrar General or a Registra", to whom it should be **The Registrar General cautions all persons against accepting or using this certificate for any purpose whatever delivered by the Person giving information to him of the particulars required by law to be registered concerning the Death. Penalty of $200 for neglect of Informant to deliver this Certificate to Registrar General or a Registrar. except that of delivering it to himself or a Registrar.
NOTICE
(to be endorsed on the back of the certificate).
By Section of the Births and Deaths Registration Ordi. nance, 189," it is required that whenever a Registered Medical Practitioner has been in attendance during the last illness of a Deceased Person, such Practitioner shall sign and give to a qualified Informant of the Death a Certificate of the Cause of Death. The Informant is bound to deliver the Certificate to the Registrar General or a Registrar of Deaths.
Persons qualified to be informants for the Registration of the Death, and to whom only this Certificate should be given.
1. A RELATIVE of the Deceased, present at the death.
2. A RELATIVE of the Deceased, in attendance during the last
illness.
3. A Person "present at the death."
4. A Person in attendance during the last illness.
5. The "Occupier" of the House in which the Death occurred.
6. An "Inmate" of the House in which the Death occurred.
7. The person
"who caused the body to be buried.'
Penalty for failing to give information within the 48 hours (in which Sundays and Government Holidays shall not be included) next following death is $200.
Informants must be prepared to state accurately to the Registrar General or a Registrar, the following particulars :---
(1) The date and place of Death.
(2) The full names and surname of Deceased.
(3) The correct age of Deceased.
(4) The rank, profession, or occupation of Deceased. [If De- ceased is a child or an unmarried person without occupa- tion or property, the full names and rank or profession of the father will be required (except in the case of illegiti mate children); if a wife or widow, those of the husband or deceased husband.]
871
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