Information Sheet for Application for Marriage License

Read the Instructions at the back before

accomplishing this form:

MALE FEMALE

Name of Applicant
(First Name, Middle Name & Surname) (First Name, Middle Name & Surname)
Date of Birth & Age & &
Place of Birth
Citizenship
Occupation
Complete Present Address:
___________________________ ___________________________
(Barangay, Municipality or City and Province) (Barangay, Municipality or City and Province)
Since When
Contact No/s.
Religion
Civil Status
Name of Father
(First Name, Middle Name & Surname) (First Name, Middle Name & Surname)
Citizenship
Complete Address
Name of Mother
(Pagkadalaga) (First Name, Middle Name & Surname) (First Name, Middle Name & Surname)
Citizenship
Complete Address

Witnesses (If to be solemnized by HON. JENNIFER N. AUSTRIA-BARZAGA City Mayor):

Please USE a separate sheet to be provided for List of Witnesses.

DO NOT WRITE BELOW THIS LINE (For CCR use only)

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Exact age at the time of marriage:

(1) Male: _________ (2) Female: __________

Interviewer @ CCR CCR’s note:

Date Applied
Release of License
Date of Marriage VINA P. SAN GABRIEL
Place of Marriage City Civil Registrar