Sample Application format for Death Certificate

[This is a sample application for the death certificate from the hospital, clinic, doctor or medical center. This application letter for a death certificate is to be used to ask for a death certificate from govt official authorities for business or job-related purposes. You can modify these formats as your requirement.]

Date…

Medical Superintendent

Institute Name…

Institute Address…

Subject: Request Letter for Death Certificate

Dear Concern,

I am writing for the death certificate of my (Relative name, with birth date) who has been passed away in this hospital yesterday after severe injuries during a road accident (Write actual cause). We moved our (Relative name) to this hospital from a local clinic for better treatment but he could not recover due to head injuries. I am attaching hospital slips from the clinic as well as of your hospital for a reference. Furthermore, you can recheck the hospital record. We need it urgently for closing his ATM cards, Bank Accounts, Licences, Mobile Numbers and Passport with Visas etc.

I request you to please issue his death certificate urgently to avoid any other incident.

Thanking You,

Name…

Relative type…

Contact no…