Sample Application format for Duplicate Death Certificate

Sample Application format for Duplicate Death Certificate

[Here briefly describe on Sample Application format for Duplicate Death Certificate. You can follow these sample format of application to send to a hospital and ask them to give you a death certificate of a close relative. You need to modify this sample according to your needs.]

Date…

Hospital Authority…

Department Name…

Hospital Name…

Address…

Sub: Application for Duplicate Death Certificate

Sir,

This application is requesting to issue a duplicate certificate of death of my (Relative type and name, e.g., grandfather). My grandfather was your patient last year/month, he was suffering with (Disease name). He remained your patient for three weeks after which he expired on a date (DD/MM/YY). (Describe in your own words). The certificate was collected by one of our relatives but unfortunately, he lost the certificate in his way home. (Explain the actual problem and situation).

I request you to issue a duplicate certificate in name of my grandfather. (Explain on requirement). All the documents and bills are enclosed with the letter.

Regards,

Your name…

Address…

Contact info and signature…

 

Another format,

Date…

Hospital Authority…

Department Name…

Hospital Name…

Address…

Sub: Application for Duplicate Death Certificate

Respected Sir/Madam,

I have sent this application to request you for a duplicate death certificate of my (Relative type and name, e.g., father). Last year during my father’s last days when he was really sick, we admitted him to your hospital. He was declared dead by the doctors on (Date: DD/MM/YY). (Describe in your own words). We did receive a death certificate but unfortunately, it has been misplaced. As I have to apply to universities and for some scholarship, I need to show them the death certificate of my father. (Explain the actual problem and situation).

I am really close to meeting my deadline so I request you kindly approve my application as soon as possible so that I can collect the document. (Explain on requirement). I assure you that such an act of responsibility will not happen again. You can contact me for any further clarification or queries.

Best Regards,

Your name…

Address…

Contact info and signature…