DECLARATION TO BE MADE BY THE BRIDEGROOM
I, A.B., hereby declare as follows:—
1. I am at the present time unmarried (or a widower or a divorcee, as the case may be).
2. I have completed ……………………… years of age.
3. I am not related to C.D. (the bride) within the degrees of prohibited relationship.
4. I am a citizen of ....…………………………
(to be filled up)
5. I am aware that, if any statement in this declaration is false, I am liable to imprisonment and
also to fine.
Sd. A.B. (the bridegroom).
DECLARATION TO BE MADE BY THE BRIDE
I, C.D., hereby declare as follows:—
1. I am at the present time unmarried (or a widower, or a divorcee, as the case may be).
2. I have completed ....... years of age.
3. I am not related to A.B. (the bridegroom) within the degrees of prohibited relationship.
4. I am a citizen of...............................................
(to be filled up)
5. I am aware that, if any statement in this declaration is false, I am liable to imprisonment and
also to fine.
Sd. C.D. (the bride).
Signed in our presence by the above named A.B. and C.D. So far as we are aware, there is no lawful
impediment to the marriage.
Sd. G.H.
Sd. I.J.
Sd. K.L. Three witnesses.
(Countersigned) E.F.
Marriage Officer
Dated the ……………………....... day of …………………………..... 19…………………..