REGION OF DAKAR REPUBLIC OF SENEGAL

ONE PEOPLE – ONE GOAL – ONE FAITH

………………
MAIN PUBLIC RECORDS OFFICE
…………..
REGISTERED MARRIAGE CERTIFICATE

Mr. ……………………, Deputy Mayor, a Public Records Official in ………………..,

Certifies that the

GROOM: (FIRST AND LAST NAMES): ……………….

DATE OF BIRTH: ………………
RESIDENCE: ………..
OCCUPATION: ……………….
FATHER’S NAME(FIRST AND LAST NAMES): …………..
MOTHER’S NAME(FIRST AND LAST NAMES):………….

And the

BRIDE: (FIRST MIDDLE AND LAST NAMES): ……………

DATE OF BIRTH: …………..
BIRTHPLACE: ……………….
RESIDENCE: L……………, and living there
OCCUPATION: …………….
FATHER’S NAME (1)(FIRST MIDDLE AND LAST NAMES)…………….
MOTHER’S NAME(FIRST AND LAST NAMES):……………..

were married in accordance with the Customary Law

The marriage by us was registered, on the following day
date: ……………….. in the following
place: ……….

The above named Groom declared opting for : Monogamy

both the bride and groom agreed upon the complete payment of a CFA Francs 3,000 dowry and
opted for a
Marriage based on Joined Ownership of Property

Signature on a CFAF200 In witness whereof, the present certificate was issued with all the rights and privileges belonging
Public Records Official Stamp thereto.
CITY OF………………
PUBLIC RECORDS OFFICE Registry Number in our File: ………

Issuance Date: ………………….

Done this day of …………….. in this Office

Signature and Stamp of the

The Pikine Public Record Office
Official