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Death Intimation Form
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Death Intimation Form
Demised Member Details
*
Membership No of demised member
Please enter Membership No of demised member.
*
Member Name
*
Date of Death (dd/MMM/yyyy)
Please enter Date of Death (dd/MMM/yyyy).
*
Intimation Form Status
*
Region
*
Allowed Actions
*
Action Remarks
Intimator Member Details
*
Association with the demised member
---Select---
Please select Association with the demised member.
*
Membership No
Please enter Membership No.
*
Name of the intimator
Please enter Name of the intimator.
*
Mobile no of intimator
Please enter Mobile no of intimator.
*
Email of the intimator
Please enter Email of the intimator.
Documents Upload
*
Death Certificate
Click here to upload
Please upload Death Certificate.
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Version 15.00.01
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