Form of Descriptive Roll

DEATH CASE

FORM OF DESCRIPTIVE DESCRIPTIVE ROLL DECEASED DETAIL

Descriptive Roll of Mr/Miss/Mst. _______________________________________ Widow/Son/Daughter of Late Mr. __________________________________________________ name of Department_________________________________ District ____________________ Post Held at the time of death _____________________________________________________ date of death ______________________ BENEFICIARY DETAIL

1) Name with Parentage _____________________ __________________________________________ ___________________________________ ______________ 2) Race ____________________ ____________________________________ ____________________________________ __________________________________ ______________ 3) Residence ______________________ _____________________________________ ____________________________________ _____________________________ ________  _________________  _________________________ ________________ ___________________ ___________________ _________________ _________________ ________________ ________ 4) Father’s Residence ___________________ ________________________________________ ________________________________________ ___________________  _________________  _________________________ ________________ ___________________ ___________________ _________________ _________________ _______________ ________ _ 5) Height __________________ 6) Age __________________ 7) Colour __________________ 8) Personal Identification Marks(if nay on the hand, fact etc.) ___________________________  _________________  _________________________ ________________ ___________________ ___________________ _________________ _________________ ______________ ________ __ 9) Place of Payment(Govt. Payment(G ovt. Treasury)_______________________________ Treasury)__________ _____________________________________ ________________ 10) Signature or Left / Right Hand Thumb and Finger Impressions. Thumb

Index Finger

Middle Finger

Ring Finger

Small Finger

Signature ______________________

Countersignatures Countersignatur es

Jerjees Haider Shah

Signature of Gazetted Officer Offi cer of the Department or First Class Magistrate