FORM MA7 CIV-5OTQ8JW (R.

5(2))

THE REPUBLIC OF KENYA

THE MARRIAGE ACT, 2014

APPLICATION FOR SPECIAL LICENCE

I MARY AWINO LOMBARDI OF MANYATTA, , KISUMU, KISUMU EAST

Hereby apply for the grant of a Special License and I hereby make oath and say as
follows-

1. A marriage is proposed to be celebrated between CHRISTOPHER JOHN HEFFORD

and myself at GARDEN, CIALA RESORT ,KISUMU on or about the 16-06-2022

2. I am not aware of any lawful impediments to the proposed marriage

3. I am 40 years of age and the said CHRISTOPHER JOHN HEFFORD is 51 years of

age

4. I am a WIDOW and the said CHRISTOPHER JOHN HEFFORD is a DIVORCED .

5. Notice of the intended marriage has not been given under rule 3 because:-
MARRIAGE BETWEEN A FOREIGN NATIONAL AND A KENYAN NATIONAL

6. I now seek dispensation for the requirements of the act relating to the giving of
notice and the issue of the certificate of the Registrar because:-
MARRIAGE BETWEEN A KENYAN AND A FOREIGN NATIONAL.

Sworn at .................................... this ................ day of ................ 20........

...........................................................
(Signature of Bridegroom)
Before Me
...........................................................
Registrar
...........................................................
(Signature of Bride)