Key No.

M0978004-24052023268
FORM No. IV
[See Rule 11 (1)]
GOVERNMENT OF KERALA
DEPARTMENT OF PANCHAYAT
CERTIFICATE OF MARRIAGE

[ Issued under rule 11 (1) of the Kerala Registration of Marriages (Common) Rules, 2008 ]

Certificate No. 400913/CRCM02/GPO/2023/2470 Dated. 26/05/2023

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 Niramaruthur Grama Panchayat

1. Date of Marriage : 17/07/2022

2. Place of Marriage : SUR PALACE AUDITORIUM
Niramaruthur Village, Tirur Taluk, Malappuram District

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

Details Husband Wife

(a) Name in full (Capital Letters) ADHAM MADAMPATT ANEESHA K

(b) Nationality Indian Indian

(c) Age and date of birth 25, 19/09/1996 20, 15/08/2001

(d) Occupation MECHANIC NIL

(e) Permanent Address MADAMPATT HOUSE, KALAD, KARUPARAMBIL HOUSE,

Niramaruthur P.O., Malappuram, KARINGAPPARA, Omachapuzha P.O.,
Kerala, India PIN: 676109 Malappuram, Kerala, India PIN: 676320

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

resident Indian

(i) Address ADHAM MADAMPATT, CUSTOM

RIDERS MOTOCYCLES, RAS AL
KHAIMAH

(ii) Security Number K05061241756718

(iii) Passport Number R6084809

(f) Name of parents or guardian and

the relationship

(i) Father IMBICHIKOYA MADAMPATT ABDUL RAHIMAN

(ii) Mother RAMLA MADAMPATT HAFSATH

(iii) Guardian

The authenticity of this certificate can be verified at https://citizen.lsgkerala.gov.in. The Key Number is unique to each event.
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Key No. M0978004-24052023268

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

Details Husband Wife

(g) Photographs:

Registration No. : 89/2023 Date of Registration : 26/05/2023

Date of Issue : 26/05/2023 12:04:36 PM

: Twenty Sixth Day of May 2023
Last Updated on 26/05/2023 (12:04) Local Registrar : Local Registrar of Marriages (Common),
Niramaruthur Grama Panchayat

Signature Not Verified

Digitally signed by BINURAJ BHARGAVAN NAIR
Date: 2023.05.26 11:55:34 IST
Reason: ILGMS Govt. of kerala

The authenticity of this certificate can be verified at https://citizen.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