Key No.

M0450004-07102022127
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. 400414/CRCM02/GPO/2022/8895 Dated. 12/10/2022

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 Ambalappuzha North Grama Panchayat

1. Date of Marriage : 14/07/2022

2. Place of Marriage : BRIDES RESIDENCE
Ambalappuzha North Village, Ambalappuzha Taluk, Alappuzha District

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

Details Husband Wife

(a) Name in full (Capital Letters) MUHAMMED HAFIZ HANNA SAMEER P A

(b) Nationality Indian Indian

(c) Age and date of birth 28, 11/11/1993 28, 19/10/1993

(d) Occupation I T ENGINEER TEACHER

(e) Permanent Address s/o ABDUL LATHEEF A, 138/A,
BARKATH MANZIL, MADACKAL,
KALAPPURA WARD, Alappuzha North
P.O., Alappuzha, Kerala, India PIN:
688007
d/o P A ABDUL SAMEER, 332,
PARATHARA, KURAVANTHODU,
PUNNAPRA, Alappuzha Medical
College,T D M C P.O., Alappuzha,
Kerala, India PIN: 688005

(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 ABDUL LATHEEF A P A ABDUL SAMEER

(ii) Mother SHAKEELA LATHEEF A JASEEMIYA

(iii) 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 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 1/2
Key No. M0450004-07102022127

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

Details Husband Wife

(g) Photographs:

Registration No. : 109/2022 Date of Registration : 10/10/2022

Date of Issue : 12/10/2022 07:52:18 PM

: Twelfth Day of October 2022
Last Updated on 10/10/2022 (12:17) Local Registrar : Local Registrar of Marriages (Common),
Ambalappuzha North Grama Panchayat

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 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