330-сон 30.06.1997. Tugʻilganlik, nikoh qayd etilganligi va oʻlim haqidagi gerbli guvohnomalar shaklini tasdiqlash, gerb yigʻimini joriy qilish toʻgʻrisida

Hujjat kuchini yo‘qotgan " " 01.07.2012

Oʻzbekiston Respublikasi Vazirlar Mahkamasining

qarori

TUGʻILGANLIK, NIKOH QAYD ETILGANLIGI VA OʻLIM HAQIDAGI GERBLI GUVOHNOMALAR ShAKLINI TASDIQLASh, GERB YIGʻIMINI JORIY QILISh TOʻGʻRISIDA

LexUZ sharhi

Mazkur qaror Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2012-yil 25-apreldagi 119-sonli “Gerbli guvohnomalar shakllarini va ularni berganlik uchun gerb yigʻimi miqdorini tasdiqlash toʻgʻrisida”gi qaroriga muvofiq oʻz kuchini yoʻqotgan.

Fuqarolik holatlari dalolatnomalarini yozish (FHDYo) organlari tomonidan aholiga beriladigan gerbli guvohnomalar shakli va mazmunini “Davlat tili haqida”gi Oʻzbekiston Respublikasi Qonuniga muvofiqlashtirish hamda FHDYo organlarini gerbli guvohnomalar bilan taʼminlashni tartibga solish maqsadida Vazirlar Mahkamasi qaror qiladi:

Oldingi tahrirga qarang.

1. Tugʻilganlik, nikoh tuzilganligi va oʻlim haqidagi gerbli guvohnomalar shakli 1-3a-ilovalarga muvofiq tasdiqlansin.

(1-band Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Oldingi tahrirga qarang.

(2-band Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2007-yil 21-dekabrdagi 263-sonli qarori bilan oʻz kuchini yoʻqotgan — OʻR QHT, 2007-y., 50-51-son, 523-modda)

Oldingi tahrirga qarang.

(3-band Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qaroriga asosan oʻz kuchini yoʻqotgan)

4. Gerb yigʻimidan tushadigan mablagʻlar gerbli guvohnomalar va fuqarolik holatlari dalolatnomasi yozuvlari shakllarini tayyorlash bilan bogʻliq xarajatlarni qoplash va FHDYo organlarini rivojlantirishga sarflash uchun Adliya vazirligi ixtiyorida qoldirilsin.

5. Mazkur qarorning bajarilishini nazorat qilish Oʻzbekiston Respublikasi Adliya vaziri S. Mirsafoyev zimmasiga yuklansin.

Oʻzbekiston Respublikasi Bosh vaziri Oʻ. SULTONOV

Toshkent sh.,

1997-yil 30-iyun,

330-son

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
1-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎ ‎	‎
TUGʻILGANLIK HAQIDA GUVOHNOMA‎ ‎ ‎	‎
Fuqaro______________________________	‎Otasi ______________________________
‎ (familiyasi)‎‎	‎ (familiyasi)‎‎
____________________________________	‎____________________________________
‎(ismi, otasining ismi)‎	‎(ismi, otasining ismi)‎
______yil________ oyining_____ kunida ‎	‎millati _____________________________
‎____________________________________	‎‎Onasi ______________________________‎
‎	‎‎(familiyasi)‎ ‎
______________________________tugʻildi	____________________________________‎
‎ (raqam va soʻz bilan)‎‎	‎‎(ismi, otasining ismi)‎‎
Tugʻilgan joyi: ____________Respublikasi‎	‎millati _____________________________
______________________________viloyati ‎	‎Qayd etish joyi_______________________
‎	‎ (FHDYo organining nomi)‎
______________________________tumani ‎	‎____________________________________
_______________shahri, shaharchasi, qishlogʻi‎	‎Berilgan vaqti____yil “___” ____________
Bu haqda ___yil ______oyining____ kunida ‎	‎
__- son bilan dalolatnoma yozuvi qayd etildi.‎	Fuqarolik holati dalolatnomalarini ‎ yozish organi mudiri ‎_________________
‎	Muhr ‎
‎	‎ ‎I—O'z №‎ 0000000 ‎ ‎ ‎
(1-ilovaning davomi)‎ ‎ ‎	‎
SVIDETELSTVO O ROJDENII‎ ‎ ‎	‎
Grajdanin (ka) ______________________	Otets_______________________________
‎(familiya)‎‎ ‎	‎(familiya)‎‎ ‎
____________________________________	____________________________________
‎(imya, otchestvo)‎‎	‎(imya, otchestvo)‎‎
rodilsya (las)‎ “____” _____________ goda	Mat_______________________________
‎	(familiya)‎ ‎ ‎‎
____________________________________‎	____________________________________
‎	(imya, otchestvo)‎ ‎ ‎
____________________________________	natsionalnost _____________________‎
(tsiframi i propisyu)‎‎	‎
Mesto rojdeniya: Respublika ___________‎	Mesto registratsii ___________________
‎	(naimenovaniye organa ZAGSa)‎‎
_____________________________ oblast‎	____________________________________‎
______________________________rayon‎	Data vidachi “ ____ ”‎ _____________ goda
gorod, posyolok, kishlak _______________‎	‎
Ob etom “ ______ ” _______________ goda‎	Zaveduщiy (aya) organom zapisi ‎aktov grajdanskogo sostoyaniya ______‎
proizvedena aktovaya zapis za № _______‎	Pechat ‎
‎	‎ ‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎
‎	‎
(1-ilovaning davomi)‎ ‎ ‎ ‎‎	‎
‎BIRTH CERTIFICATE‎ ‎	‎
‎Citizen ______________________________	Father _______________________________
‎(surname)‎	‎(surname)‎
‎____________________________________	‎____________________________________
‎(given names)‎	‎(given names)‎
‎was born on __________________________	nationality (etnic) _______________________
‎(day, month, year in figures and words)‎	‎
‎____________________________________	Mother ______________________________ ‎
‎	‎(surname)‎ ‎‎
‎____________________________________	‎____________________________________
‎	‎‎‎(given names) ‎ ‎‎
Place of birth: Republic __________________‎	nationality (etnic) ______________________ ‎
_______________________________region‎	Place of registration _____________________
‎	‎‎(name and location of the Registry Office)‎
______________________________district‎	____________________________________‎
___________________________city, village.‎	Date of issue “ ___ ”‎ ___________________
‎Birth record No. ____ was filed on _________	‎Registrar _______________________‎
‎(day, month, year)‎‎	‎
‎	Seal‎
‎	‎ ‎‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎ ‎

(1-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
1a-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎ ‎	‎
TUGʻILGANLIK HAQIDA GUVOHNOMA‎ TUOʻЫLGʻANLЫGʻЫ HAQQЫNDA GҮOʻALЫQ ‎ ‎ ‎	‎
Fuqaro_____________________________	‎Otasi __________________________________
Puxara ‎‎(familiyasi/familiyasi)‎	Ekesi ‎(familiyasi/familiyasi)
_______________________________________	‎_______________________________________
(ismi, otasining ismi/ati, Ekesiniң ati)‎	(ismi, otasining ismi/ati, Ekesiniң ati)‎
______yil _______ oyining ________ kunida ‎ ‎_________jil _______ ayinin______ kuni ‎	‎millati _______________________________ ‎milleti
‎____________________________________	‎‎Onasi _________________________________ ‎Anasi
‎	(familiyasi/familiyasi)‎
________________________________ tugʻildi	_______________________________________‎
(raqam va soʻz bilan/san hem soz benen)‎ ‎ tugʻildi	(ismi, otasining ismi/ati, Ekesiniң ati)‎
Tugʻilgan joyi: _______________Respublikasi‎ Tuoʻilgʻan jeri:_____________________Respublikasi	‎millati ________________________________ ‎mileti
_________________viloyati	‎Qayd etish joyi _________________________
oblasti‎‎	Dizimge alingʻan jeri (FHDYo organining nomi)‎
‎	_______________________________________ ‎
‎	(FHDYo organining nomi/PXAJ organiniң ati)‎‎
____________tumani ‎‎ ‎rayoni	‎_______________________________________
____________ shahri, shaharchasi, qishlogʻi‎ ____________ qalasi, posyolkasi, aoʻili.	‎Berilgan vaqti____yil “____” _____________ ‎Berilgen oʻaqti ___jil “____” ____________
Bu haqda ___yil ______oyining__ kunida ‎Bul haqqinda___jil __ayiniң___ kүni‎	‎
___son bilan dalolatnoma yozuvi qayd etildi.‎ ‎‎san menen akt jazioʻi dizimge alindi.‎	Fuqarolik holati dalolatnomalarini ‎ yozish organi mudiri ‎_________
	‎Puxaraliq halati aktlerin ‎jazioʻ organi basligʻi _______‎
‎	Muhr ‎ ‎Mor
‎	‎ ‎I—QQ №‎ 0000000 ‎ ‎ ‎
(1-ilovaning davomi)‎ ‎ ‎	‎
SVIDETELSTVO O ROJDENII‎ ‎ ‎	‎
Grajdanin (ka) ______________________	Otets_______________________________
‎(familiya)‎‎	‎(familiya)‎‎
____________________________________	____________________________________
‎(imya, otchestvo)‎‎	‎(imya, otchestvo)‎‎
rodilsya (las)‎ “____” _____________ goda	Mat_______________________________
‎	‎ ‎(familiya)‎ ‎ ‎‎
____________________________________‎	____________________________________
‎	‎‎(imya, otchestvo)‎ ‎ ‎‎
____________________________________	natsionalnost _____________________
‎(tsiframi i propisyu)‎‎	‎
Mesto rojdeniya: Respublika ___________‎	Mesto registratsii ___________________
‎	‎(naimenovaniye organa ZAGSa)‎‎
_____________________________ oblast‎	_____________________________‎________________
______________________________rayon‎	Data vidachi “ ____ ”‎ _____________ goda
gorod, posyolok, kishlak _______________‎	‎
Ob etom “ ______ ” _______________ goda‎	Zaveduщiy (aya) organom zapisi ‎aktov grajdanskogo sostoyaniya _________‎
proizvedena aktovaya zapis za № _______‎	Pechat ‎
‎	‎ ‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎
‎	‎
(1a-ilovaning davomi)‎ ‎ ‎ ‎‎	‎
‎BIRTH CERTIFICATE‎ ‎	‎
‎Citizen ______________________________	Father ______________________________
‎(surname)‎	‎(surname)‎
___________________________________	‎____________________________________
‎(given names)‎	‎(given names)‎
‎was born on __________________________ ‎(day, month, year in figures and words)	nationality (etnic) ______________________
‎____________________________________	Mother _____________________________
‎	‎(surname)‎ ‎‎
‎____________________________________	‎____________________________________
‎	‎‎‎(given names) ‎ ‎
Place of birth: Republic _________________‎	nationality (etnic) ______________________ ‎
_______________________________region‎	Place of registration ____________________
‎	‎‎(name and location of the Registry Office)‎
______________________________district‎	____________________________________‎
___________________________city, village.‎	Date of issue “ ____ ”‎ __________________
‎Birth record No. ____ was filed on _________	‎Registrar _________________________‎
‎(day, month, year)‎‎	‎
‎	Seal‎
‎	‎ ‎‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎ ‎

(1a-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
2-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎ ‎	‎
NIKOH TUZILGANLIGI HAQIDA GUVOHNOMA‎ ‎ ‎	‎
Fuqaro_________________________________ ‎ (familiyasi)‎	Bu haqda_____yil______oyining______kunida
_______________________________________ ‎(ismi, otasining ismi)‎	_______-son bilan dalolatnoma yozuvi qayd etildi.
tugʻilgan vaqti______yil “ ____ ”___________	Nikoh qayd etilgandan keyin quyidagi familiyalar berildi:
tugʻilgan joyi ___________________________	eriga __________________________________
_______________________________________ ‎_______________________________________	xotiniga _______________________________
va fuqaro_______________________________ ‎(familiyasi)	Qayd etish joyi _________________________ ‎(FHDYo organining nomi)
_______________________________________ ‎(ismi, otasining ismi) ‎	_______________________________________
Tugʻilgan vaqti_____yil “_______”______________	Berilgan vaqti____ yil “ _______ ”_____________
tugʻilgan joyi ___________________________
_______________________________________ ‎_______________________________________	Fuqarolik holati dalolatnomalarini ‎ ‎yozish organi mudiri ‎_____________________
_____yil___________oyining________kunida
‎_______________________________________	Muhr ‎
__________________________nikoxlandilar. ‎‎ ‎(raqam va soʻz bilan)‎	‎
‎	‎ ‎I—O'z №‎ 0000000 ‎ ‎ ‎
(2-ilovaning davomi)‎ ‎ ‎	‎
SVIDETELSTVO O ZAKLYuChENII BRAKA‎ ‎ ‎	‎
Grajdanin______________________________ ‎(familiya)‎	Ob etom “ ____ ” __________________ goda
_______________________________________‎(imya, otchestvo)‎	proizvedena aktovaya zapis za № ____________.
data rojdeniya ‎ “____” ________________ goda	Posle registratsii braka prisvoyeni familii:
mesto rojdeniya _________________________‎	muju __________________________________
_______________________________________ _______________________________________‎	jene __________________________________
i grajdanka _____________________________ ‎(familiya)‎	Mesto registratsii _______________________ ‎(naimenovaniye organa ZAGSa)
_______________________________________ ‎(imya, otchestvo)	______________________________________
data rojdeniya ‎ “____” _______________ goda	data vidachi ‎ “_____” ________________ goda
mesto rojdeniya _________________________‎	‎
_______________________________________ _______________________________________	Zaveduщiy (aya) organom zapisi ‎aktov grajdanskogo sostoyaniya ____________‎
zaklyuchili brak “ __ ” _______________ goda‎	Pechat ‎
‎_______________________________________ ______________________________________‎ ‎(tsiframi i propisyu)	‎ ‎ ‎ ‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎
‎	‎
(2-ilovaning davomi)‎ ‎ ‎ ‎‎	‎
MARRIAGECERTIFICAT‎E ‎	‎
_______________________________________ ‎(surname)	Marriage record No. ___ was filed on __________ ‎(day, month, year)
‎_______________________________________ ‎(given names)	In the marriage the following surnames were given to
‎date of birth _____________________________ ‎(day, month, year)	husband ________________________________
place of birth_____________________________	wife____________________________________
‎______________________________________________________________________________	Place of registration _______________________ ‎(name and location of the Registry Office)
and ___________________________________ ‎(surname)	______________________________________
‎_______________________________________ ‎(given names)	Date of issue “ ____ ” _____________________
‎date of birth _____________________________ ‎(day, month, year)
place of birth_____________________________	‎Registrar _________________________‎
‎_______________________________________ _______________________________________‎
married on ______________________________ ‎(day, month, year in figures and words)‎	Seal‎ ‎
‎_______________________________________ _______________________________________‎	‎
‎
‎	‎ ‎‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎ ‎

(2-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
2a-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎ ‎	‎
NIKOH TUZILGANLIGI HAQIDA GUVOHNOMA‎ ‎NEKE DYZILGENLIGI HAQQЫNDA GYOʻALЫQ ‎ ‎	‎
Fuqaro Puxara _________________________ ‎‎(familiyasi/familiyasi) ‎ ‎	Bu haqda____yil_______oyining______kunida ‎Bul haqqinda_____ jil____ ayiniң____ kүni
_______________________________________ (ismi, otasining ismi/ati, Ekesiniң ati)	_____-son bilan dalolatnoma yozuvi qayd etildi. ______-‎san menen akt jazioʻi dizimge alindi.
tugʻilgan vaqti____yil “ ___ ”______________ tuoʻilgʻan oʻaqti____jil “ ____ ”___________ ‎	Nikoh qayd etilgandan keyin quyidagi familiyalar berildi: ‎Neke dүzilgennen keyin tomendegi familiyalar berildi:
tugʻilgan joyi ___________________________ tuoʻilgʻan jeri __________________________‎	eriga yerine_____________________________
__________________________________________________ ‎____________________________________	xotiniga hayalina_________________________
va fuqaro hem puxara_____________________ (familiyasi/familiyasi)	Qayd etish joyi Dizimge alingʻan jeri______ (FHDYo organining nomi/PXAJ organiniң ati)
_______________________________________ (ismi, otasining ismi/ati, Ekesiniң ati)	_______________________________________
Tugʻilgan vaqti_____yil “_______”_________ tuoʻilgʻan jeri __________________________‎	Berilgan vaqti____ yil “ _____ ”___________ ‎Berilgen oʻaqti ____jil“ ______ ”_________
tugʻilgan joyi ___________________________ tuoʻilgʻan jeri __________________________‎
_______________________________________ ‎_______________________________________	Fuqarolik holati dalolatnomalarini ‎ ‎yozish organi mudiri ‎_____________________ ‎Puxaraliq halati aktlerin ‎jazioʻ organi basligʻi __________________
_____yil__________oyining________kunida _____‎jil___________ayinin________kuni
‎_______________________________________	Muhr ‎Mor‎
_________________nikohlandilar. nekelesti. ‎‎ ‎(raqam va soʻz bilan/san hem soz benen)	‎
‎	‎ ‎I—QQ №‎ 0000000 ‎ ‎ ‎
(2a-ilovaning davomi)‎ ‎ ‎	‎
SVIDETELSTVO O ZAKLYuChENII BRAKA‎ ‎ ‎	‎
Grajdanin______________________________ ‎(familiya)‎	Ob etom “ ____ ” ___________________ goda
_______________________________________ ‎(imya, otchestvo)‎	proizvedena aktovaya zapis za № ____________.
data rojdeniya ‎ “____” ________________ goda	Posle registratsii braka prisvoyeni familii:
mesto rojdeniya _________________________‎	muju __________________________________
_______________________________________ _______________________________________‎	jene __________________________________
i grajdanka _____________________________ ‎(familiya)‎	Mesto registratsii _______________________ ‎(naimenovaniye organa ZAGSa)
_______________________________________ ‎(imya, otchestvo)	_______________________________________
data rojdeniya ‎ “____” _______________ goda	data vidachi ‎ “_____” _______________ goda
mesto rojdeniya ________________________‎	‎
_______________________________________ _______________________________________	Zaveduщiy (aya) organom zapisi ‎aktov grajdanskogo sostoyaniya ____________‎
zaklyuchili brak “ _____ ” ____________ goda‎	Pechat ‎
�_______________________________________ _______________________________________ ‎(tsiframi i propisyu)	‎ ‎ ‎ ‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎
‎	‎
(2a-ilovaning davomi)‎ ‎ ‎ ‎‎	‎
MARRIAGECERTIFICAT‎E ‎	‎
_______________________________________ ‎(surname)	Marriage record No. _____ was filed on ________ ‎(day, month, year)
‎_______________________________________ ‎(given names)	In the marriage the following surnames were given to
‎date of birth _____________________________ ‎(day, month, year)	husband ________________________________
place of birth___________________________________	wife____________________________________
‎_______________________________________ _______________________________________‎	Place of registration _____________________________ ‎(name and location of the Registry Office)
and ___________________________________ ‎(surname)	_____________________________________________
‎_______________________________________ ‎(given names)	Date of issue “ ____ ” _____________________
‎date of birth _____________________________ ‎(day, month, year)
place of birth_____________________________	‎Registrar _________________________‎
‎_______________________________________ _______________________________________‎
married on ______________________________ ‎(day, month, year in figures and words)‎	Seal‎ ‎
‎_______________________________________ _______________________________________	‎
‎
‎	‎ ‎‎‎‎I—O'z №‎ 0000000 ‎ ‎ ‎ ‎ ‎

(2a-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
3-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎‎ ‎ ‎
OʻLIM HAQIDA GUVOHNOMA‎‎
‎‎Fuqaro ________________________________________________________________________ ‎(familiyasi)
_______________________________________________________________________________‎‎ ‎‎(ismi, otasining ismi)
________________ yil________________________ oyining______________________ kunida
‎‎_______________________________________________________________________________ ‎(raqam va soʻz bilan)
_________________________________________________________________ yoshda vafot etdi.
‎Bu haqda ______yil _________ oyining_____ kunida______-son dalolatnoma yozuvi qayd etildi.
Oʻlimning sababi ________________________________________________________________ ‎_______________________________________________________________________________ ‎_______________________________________________________________________________
‎Vafot etgan joyi:____________________________________________________ Respublikasi
_______________________________________________________________________viloyati
_________________________________________________________________________tumani
_______________________________________________________shahri, shaharchasi, qishlogʻi
‎Qayd etish joyi ________________________________________________________________ ‎(FHDYo organining nomi) ‎_______________________________________________________________________________
‎‎‎Berilgan vaqti______ yil ‎ “ ______ ” _______________________________________________
‎‎ ‎Fuqarolik holati dalolatnomalarini ‎ yozish organi mudiri‎ ___________________
‎Muhr‎	‎
‎	‎
‎ ‎‎‎I—O'z № 0000000‎
‎‎ ‎ ‎ ‎ ‎‎
‎‎(3-ilovaning davomi)‎ ‎ ‎ ‎
‎‎SVIDETELSTVO O SMERTI‎
‎‎Grajdanin (ka)__________________________________________________________________ ‎(familiya)‎
_______________________________________________________________________________‎‎ ‎(imya, otchestvo)
“ ______ ” ________________________________________________________________ goda
______________________________________________________________________________‎‎ ‎‎(tsiframi i propisyu) ‎‎‎
umer (la) v vozraste ______________________________________________________________ ‎Ob etom “ ______ ” _________________________________________________________ goda
‎Proizvedena aktovaya zapis za № ___________________.‎‎‎
‎Prichina smerti _________________________________________________________________ ‎_______________________________________________________________________________ ‎_______________________________________________________________________________
‎‎mesto smerti: Respubliki___________________________________________________________________
_______________________________________________________________________ oblast‎
_______________________________________________________________________rayon
gorod, posulok, kishlak ____________________________________________________________
Mesto registratsii _______________________________________________________________ ‎(naimenovaniye organa ZAGSa)
‎‎_______________________________________________________________________________
‎‎Data vidachi “ _______ ”‎ ______________________________________________________ goda
‎‎ ‎ ‎Zaveduyuщiy(aya) organom zapisi ‎aktov grajdanskogo sostoyaniya ____________________________________‎
‎ ‎Pechat‎	‎
‎ ‎‎‎ ‎‎‎I—O'z № 0000000‎
‎ ‎ ‎ ‎ ‎‎	‎
‎‎‎‎‎(3-ilovaning davomi)‎ ‎ ‎ ‎ ‎ ‎
DEATH CERTIFICATE‎ ‎
____________‎‎_______________________________________________________________________________‎ ‎(surname)
_______________________________________________________________________________ ‎(given names)‎‎‎
died on_________________________________________________________________________ ‎(day, month, year in figures and words)‎‎‎
‎‎______________________________________________________________________________‎‎
at the age of _____________________________________________________________________ ‎Death record No. _______________ was failed __________________________________________ ‎(day, month, year)
Cause of death: Republic ___________________________________________________________
__________________________________________________________________________region
_________________________________________________________________________ district
____________________________________________________________________ city, willage
Place of registration _______________________________________________________________ ‎(name and location of the Registry Office)
‎‎_______________________________________________________________________________
‎‎Date of issue ____________________________________________________________________ ‎(day, month, year)‎
‎ ‎‎Registrar _______________________‎	‎ ‎
‎ ‎Seal‎	‎
‎‎ ‎ ‎‎‎ ‎‎‎ ‎‎‎I—O'z № 0000000‎
‎	‎

(3-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)

Vazirlar Mahkamasining
1997-yil 30-iyundagi 330-son qaroriga
3a-ILOVA

Oʻzbekiston Respublikasi ‎GERBI‎‎ ‎ ‎
OʻLIM HAQIDA GUVOHNOMA‎‎ ‎OLIM HAQQЫNDA GҮOʻALЫQ
‎‎Fuqaro Puxara _________________________________________________________________ (familiyasi/familiyasi)
_______________________________________________________________________________‎‎ (ismi, otasining ismi/ati, Ekesiniң ati)
________________ yil_______________________ oyining______________________ kunida ________________‎jil_____________________________ ayiniң___________________ kүni
‎‎_______________________________________________________________________________ ‎(raqam va soʻz bilan/san hem soz benen) ‎ ‎
_________________________________________________________________ yoshda vafot etdi. ‎_____________________________________________________________________ jasta oldi.
‎Bu haqda _______________yil _____________________ oyining_________________ kunida ‎Bul haqqinda ______________jil _______________ayiniң _____________________kүni
‎___________-son dalolatnoma yozuvi qayd etildi. _______-‎san menen akt jazioʻi dizimge alindi. ‎
Oʻlimning sababi Oliminiң sebebi_________________________________________________ ‎_______________________________________________________________________________ ‎_______________________________________________________________________________
‎Vafot etgan joyi: Olgen jeri:_____________________________ Respublikasi Respublikasi
________________________________________________________________viloyati oblasti
_________________________________________________________________tumani rayoni
__________________________________shahri, shaharchasi, qishlogʻi qalasi, posyolkasi, aoʻili.
‎Qayd etish joyi Dizimge alingʻan jeri______________________________________________ ‎(FHDYo organining nomi/PXAJ organiniң ati) ‎‎_______________________________________________________________________________
‎‎‎Berilgan vaqti______ yil ‎ “ ______ ” ______________________________________________ Berilgen oʻaqti______ jil ‎ “ ______ ” ______________________________________________
‎‎ ‎Fuqarolik holati dalolatnomalarini ‎ yozish organi mudiri‎ ___________________ ‎Puxaraliq halati aktlerin ‎ jazioʻ organi basligʻi ________________
‎Muhr‎ ‎Mor	‎
‎	‎
‎ ‎‎‎I—QQ № 0000000‎
‎‎ ‎ ‎ ‎ ‎‎
‎‎(3a-ilovaning davomi)‎ ‎ ‎ ‎
‎‎SVIDETELSTVO O SMERTI‎
‎‎Grajdanin (ka)__________________________________________________________________ ‎(familiya)‎
_______________________________________________________________________________‎‎ ‎(imya, otchestvo)
“ ______ ” _________________________________________________________________ goda
______________________________________________________________________________‎‎ ‎‎(tsiframi i propisyu) ‎‎‎
umer (la) v vozraste _____________________________________________________________ ‎Ob etom “ ______ ” _________________________________________________________ goda
‎Proizvedena aktovaya zapis za № ___________________.‎‎‎
‎Prichina smerti ________________________________________________________________ ‎_______________________________________________________________________________ ‎_______________________________________________________________________________
‎‎mesto smerti: Respubliki__________________________________________________________________
______________________________________________________________________ oblast‎
________________________________________________________________________rayon
gorod, posulok, kishlak ___________________________________________________________
Mesto registratsii ______________________________________________________________ ‎(naimenovaniye organa ZAGSa)
‎‎______________________________________________________________________________
‎‎Data vidachi “ _______ ”‎ _____________________________________________________ goda
‎‎ ‎ ‎Zaveduyuщiy(aya) organom zapisi ‎aktov grajdanskogo sostoyaniya ____________________________________‎
‎ ‎Pechat‎	‎
‎ ‎‎‎ ‎‎‎I—O'z № 0000000‎
‎ ‎ ‎ ‎ ‎‎	‎
‎‎‎‎‎(3a-ilovaning davomi)‎ ‎ ‎ ‎ ‎ ‎
DEATH CERTIFICATE‎ ‎
____________‎‎___________________________________________________________________‎ ‎(surname)
_______________________________________________________________________________ ‎(given names)‎‎‎
died on_________________________________________________________________________ ‎(day, month, year in figures and words)‎‎‎
‎‎_______________________________________________________________________________‎‎
at the age of ____________________________________________________________________ ‎Death record No. _____________ was failed ____________________________________________ ‎(day, month, year)
Cause of death: Republic ___________________________________________________________
_________________________________________________________________________region
________________________________________________________________________ district
____________________________________________________________________ city, willage
Place of registration ______________________________________________________________ ‎(name and location of the Registry Office)
‎‎_______________________________________________________________________________
‎‎Date of issue ____________________________________________________________________ ‎(day, month, year)‎
‎ ‎‎Registrar _______________________‎	‎ ‎
‎ ‎Seal‎	‎
‎‎ ‎ ‎‎‎ ‎‎‎ ‎‎‎I—O'z № 0000000‎
‎	‎

(3a-ilova Oʻzbekiston Respublikasi Vazirlar Mahkamasining 2003-yil 5-iyundagi 249-sonli qarori tahririda)