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Manipal Form 00 Fou
To be sonora in quacrplate wang Baar
(Revised January 2007) Republic of the Philippines
OFFICE OF THE CIVIL REGISTRAR GENERAL
APPLICATION FOR MARRIAGE LICENSE
Province. Regiety No,
ICity/Municipality.
Receivedby. Mariage License No.,
Date of Receipt: Date of Issuance of Marriage License
‘GROOM BRIDE
‘The Civil Registrar ‘The Civil Registrar
SiMadam: SitiMadam:
‘May L apply fora license to contract marriage with May Lapply fora license to contract marrage with
and to this effect, and io this effect,
being duly sworn, I hereby depose and say that I have all the
necessary qualifications and none ofthe legal dsqualificaions
to contract the said marriage, and that the following data are
true and correct to the best of my knowledge and information:
Ieing diy sworn, Thereby depose and say that I have all the
necessary qualifications and none ofthe legal disqualfications
to contract the said marriage, and that the following data are
true and correct tothe best of my knowledge and information:
ree
as
[Link] of
Applicant
ee
(Mi
Age
2, Date of Bitty
evesy ar
3. Place of Birt
WemsT
a Sed
Gttzonship
‘Warman THRT
5. Residence
‘Tess, 8 Baga Ebay Ps COORTT
[Link]!
Religious Sect
7. Chl Status
MARRIED: Hom
non coches?
easy
9. Place where
deeolved
easy
10, Date when
dissolved
Fi Degee of
ecto
cerca prc)
ae)
72, Name of
Father
way
13, Chtzonship|
(Moo, 8, Bag Chyna Pinan Cty)
14, Residence
(Goin 8 women Chaney Per, COaty)
oe aber war
75: Maldon Name
of Mother
rt sae)
16. Clizenship
aS Raw Chapa Pen Sh
17. Residence
‘Peas Dagan Canepa Fo CORT)
8 Pasae wo
ave coca ot
‘eves
19, Relationship
20. citzenship
‘aan, Banga Cnn Pen Cas)
24, Residence
eo, aa Cp en OT
(Banature of Applicant)
‘Bianature of Applicant)
SUBSCRIBED AND SWORN 10 before me shit
by of.
rit ines atin to
‘ied ome a Commit Tax Cert ined
(Sirature Over Printed Name of te Ci Registrar)
SUBSCRIBED AND SWORN 10 before me this
ey of. _ a
Pippin ian who
famed
‘ibid ome he Commi Ta Cet,
(Sionature Over Printed Name ofthe Ovi Registar)
