FORM-V

See Rule-7 (1)

Application for Registration of Marriage

U/s 15 of the special marriage Act. 1954. (Act 43 of 1954

HUSBAND WIFE
1. Name of Parties

2. Father's Name

3. Age & Date of Birth

4. Present dwelling
Place if any

5. Permanent dwelling
Place

6. Relationship if any
Parties before marriage

7. A Ceremony of marriage was performed between

and on and we declare that

we have been living together as husband and wife noted above We hereby declare that.
i) Neither of us have more that one spouse living on the date mentioned in the application or
shall have such on the time of registration.
ii) Neither of us is idiot or lunatic.
iii) Both of us have completed the age of years on the date of registration.
iv) We are within the degree of prohibited relationship of marriage as deliberated to
force the commencement of the special Marriage Act. 1954 (XLIII of 1954) and
according to the law customs or us age having the force of low governing each of us.
A marriage between us is permitted through we are within the degree of prohibited
relationship according the act aforesaid.
v) We/have been residing within the jurisdiction of the Marriage
Officer for Khurda District. At/P.o.- Bhubaneswar for a period of not less than thirty days
immediately proceed the date of this application.

We also declare that all the above particulars are true the best of our knowledge belief

Date :- Signature of Husband •

Place :- Signature of Wife
Cont....
 SPECIAL MARRIAGE ACT. 1954 (U/S-15)

Regarding Registration of Marriage Celebrated in other forms :

1. Any Marriage Celebrated whether before or after the commencement of this Act, other
than a marriage solemnized under the Special Marriage Act 3 of1872 or under this Act may
be registered under this Chapter by a Marriage Officer in the territories to which this Act
extends if the following conditions are fulfilled namely :

a) a ceremony of marriage has been performed between the parties and they have been
living together as husband and wife eversince
b) neither party has atthe time of registration more than one spouse living.
c) neither party is an idiot or a lunatic atthe time of registration
d) the parties have completed the age of twenty one years at the time of registration
e) the parties are not within the degrees of prohibited relationship.
f) the parties have been residing within the district of the Marriage Officer for a period of
not less than thirty days immediately proceeding the date on which the application is
made to him for registration of the marriage.

2. Application for Registration of marriage

After filling the application for Registration of marriage and duly signed my both parties
may submit then application by any one of the parties directly to the Marriage Officer, for
Khurda District at Bhubaneswar or may send their application by post. The requisite fees
of Rs 3/- by money order mentioning the names of the parties in the money order coupon.
The parties have to attach the money order receipt with their application form while
sending by post.

(For Example: Fees for Application for Registration of Marriage between :-

Husband and wife

The Notices/Applications/Money orders to be addressed to :-

MARRIAGE OFFICER (Under the Special Marriage Act 1954)

CUM

DISTRICT SUB-REGISTRAR

FOR KHURDA DISTRICT

AT/ PO-BHUBANESWAR-751014