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NOT FOR SALE

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF FOREIGN AFFAIRS

Form Prescribed by FSC 75-94


(REVISED JUNE 2013)

REPORT OF MARRIAGE

DATE OF REPORT
(day-month-year)

OF A PHILIPPINE CITIZEN ABROAD


THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE

Foreign Service Post:

PHILIPPINE EMBASSY MOSCOW, RUSSIAN FEDERATION

PARTICULARS OF CONTRACTING PARTIES


HUSBAND

WIFE

1. LAST NAME
2. FIRST NAME
3. MIDDLE NAME
4. DATE OF BIRTH
(day-month-year)

5. AGE
6. PLACE OF BIRTH
7. CITIZENSHIP
8. RESIDENCE
9. CIVIL STATUS

[ ] SINGLE

[ ] DIVORCED

[ ] WIDOW/WIDOWER

[ ] SINGLE

[ ] DIVORCED

[ ] WIDOW/WIDOWER

10. RELIGION
11. OCCUPATION
12. FATHER'S FULL NAME
13. CITIZENSHIP
14. MOTHER'S FULL NAME
15. CITIZENSHIP
16. NAME OF WITNESS 1
17. RESIDENCE
18. NAME OF WITNESS 2
19. RESIDENCE
20. DATE OF MARRIAGE

21. PLACE OF MARRIAGE

22. NAME OF SOLEMNIZING/ OFFICIATING OFFICER


23. TITLE OF SOLEMNIZING/ OFFICIATING OFFICER
We/I solemnly swear under penalty of law that the statements made on this report are true and correct, and the attached supporting documents are authentic; and we/I
hereby set our hand/s this ___________ day of ________________________________ at ________________________________________________________________.

Signature of Husband: _____________________________________________________

Signature of Wife: ____________________________________________

EMBASSY/CONSULATE OF THE REPUBLIC OF THE PHILIPPINES


The marriage was today registered with the Embassy/ Consulate under No. ___________________________ of the Civil Registry Book. This report has been executed in a
quadruplicate, copy furnished the contracting parties, copy transmitted to the Department of Foreign Affairs (DFA) in Manila, copy transmitted to the Civil Registrar
through the DFA, and copy places in the files of this Embassy/Consulate together with the following supporting documents:
[ ] MARRIAGE CERTIFICATE

Date : _____________________
Doc. No. ___________________
Service No. _________________
O.R. No. ____________________
Fee Paid ___________________
Book No. ___________________
Series of ___________________

[ ] COPIES OF PASSPORTS OF CONTRACTING PARTIES

SEAL

REPUBLIC OF THE PHILIPPINES