Key No. M01710012012015003000 FORM No.

IV
[See Rule 11(1)]
GOVERNMENT OF KERALA
DEPARTMENT OF URBAN AFFAIRS
CERTIFICATE OF MARRIAGE
[ Issued under rule 11 (1) of the Kerala Registration of Marriages (Common) Rules, 2008 ]

Certificate No. 3447/2015 Dated. 02/03/2021

This is to certify that the following information has been taken from the Register of Marriages (Common) maintained in Form No. III
in the Office of the Local Registrar of KOZHIKODE CORPORATION

1. Date of Marriage : 07/01/2015

2.Place of Marriage : CSI Cathedral

Kasaba Village, Kozhikode Taluk, Kozhikode District

3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife

(a) Name in full (Capital Letters) DANIEL MOSES JANE BELINDA MOHAN

(b) Nationality Indian Indian

(c) Age and date of birth 28, 04/08/1986 26, 21/12/1988

(d) Occupation Public Information Officer Corporate OfficeStaff

(e) Permanent Address 11/44, Payyadi Meethal Paramba, Calicut, Plot No.42,Devi Karumari Amman nagar, Ist
Merikkunnu, Kozhikode, Kerala - 673012 Street, velachery, Chennai, Tamil Nadu -
600042

(e.a) where the husband is a Non - resident

Indian
(i) Address NA

(ii) Security Number NA

(iii) Passport Number NA

(f) Name of parents or guardian and the

relationship
(i) Father VINCENT LEBOY MOSES MOHAN EDWARD

(ii) Mother PUSHPALATHA SHIRLEY JANET EVELINE MOHAN

(ii) Guardian

This certificate is computer generated and does not require any Seal/Signature in original.
The Govt. vide G.O.(P) 6/2013/Law Dated 09/10/2013 has approved this certificate as a valid document for all official purposes
The authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
Page 1/2
Key No. M01710012012015003000

3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife

(g) Photographs:

Registration No. 167/2015 Date of Registration : 14/01/2015

Date of Issue : 02/03/2021 (14:01)

: Second Day of March 2021

Last Updated on 01/08/2015 (17:16) Local Registrar : Local Registrar of Marriages (Common) ,
KOZHIKODE CORPORATION

This certificate is computer generated and does not require any Seal/Signature in original.
The Govt. vide G.O.(P) 6/2013/Law Dated 09/10/2013 has approved this certificate as a valid document for all official purposes
The authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
Page 2/2