ANNEXURE 3
Application cum verification
Application-cum-verification form (For Marriage Registration)
Government of State Haryana
We hereby apply to the Government of State Haryana for registration of marriage
as per the particulars below:
Sr. Particulars HUSBAND WIFE
No.
1. Name of applicant JITENDER SHRMA KUMARI ARTI
2. Father’s Name RAMKARAN KASHMIRI LAL
3. Mother’s Name PRAMILA DEVI LAAJWANTI
4. Nationality (Indian/Foreign Indian Indian
National /NRI) Yes/No
Religion HINDU HINDU
5.
6. Full Address R/o Vill Sabilpur Tehsil R/o Vill JAKHRI Tehsil
and District Panchkula and District Panchkula
State Haryana 134204, State Haryana 134205,
India India
7. Date of Birth 04-08-2001 12-11-2000
8. Age at the time of marriage 23 Years 24 Years
9. Civil Condition at the time of Un-married Un-married
Marriage
10. Date of Marriage 06-03-2025
11. Place of Marriage R/o Vill Jalkhri Tehsil and
District Panchkula State
Haryana 134205, India
We hereby declare that one of us has Indian Nationality and that all the above details are
complete and true to the best of our knowledge and that we bear the liability of my false
information provided by us.
Signature of Husband _________________ Signature of Wife_________________
Signature of Witnesses _________________ Signature of Witness ________________
For Office use
Remarks Place of Registration___________________
Full Name of Marriage Registrar_________________
Designation _________________________________
Date _______________________________ Signature_________________________
Form No. I
{See rule 3(3) (a) and 4(a)}
Application for Registration of Marriage under the
State Haryana Compulsory Registration of Marriage Act, 2008 (6 of 2008).
To
The Registrar of Marriages,
E.O./Secretary/Tehsildar
Please register our marriage, the particulars of which are given below:-
Sr. Particulars Details of Husband Details of wife
No.
JITENDER SHRMA KUMARI ARTI
1. Full Name
KASHMIRI LAL
2. Father’s Name RAMKARAN
PRAMILA DEVI LAAJWANTI
3. Mother’s Name
4. Nationality Indian Indian
5. Religion Hindu Hindu
R/o Vill Sabilpur Tehsil R/o Vill JAKHRI Tehsil
6. Full Address and District Panchkula and District Panchkula
State Haryana 134204, State Haryana 134205,
India India
7. Date of Birth 04-08-2001 12-11-2000
Age as on the date of 23 Years 23 Years
8. marriage
Civil Condition at Un-married Un-married
9. the time of
Marriage
Date of Marriage 06-03-2025
R/o Vill Jakhri Tehsil and District Panchkula State
Place of Marriage Haryana 134205, India
Date ………… Signature of Husband Signature of Wife
Form No. II
{See rule 3(3) (b) and 7(a)}
Marriage Registration Register
Register of Marriage for Naraingarh Tehsil/Sub-Tehsil/City for the year 2024
1 Photo of couple
2 Date of marriage and 06-03-2025 R/o Vill JAKHRI Tehsil and
District Panchkula State
place of marriage
Haryana 134205, India
3 Name and address of R/o Vill Sabilpur Tehsil and
JITENDER SHRMA District Panchkula State
husband
Haryana 134204, India
4 His age at the time of 23 Years
marriage
5 Nationality and religion
of husband Indian Hindu
6 Name and address of R/o Vill Sabilpur Tehsil and
District Panchkula State
wife Kumari Arti
Haryana 134204, India
7 Her age at the time of
marriage 23 Years
8 Nationality and religion Indian Hindu
of wife
9 Date of registration of 06-03-2025
marriage
10 Signature of Registration
and remarks
Certified that all information provided in the form is true to the best of my
knowledge and belief and nothing has been concealed therein. It is also certified
that this marriage has not been registered earlier anywhere in India/Abroad. We
shall be liable for action as per the law, if we have violated any provision of any
law of the land.
Date ………….. Signature of Husband Signature of Wife
AFFIDAVIT
I, JITENDER SHRMA S/O Sh. RAMKARAN R/o R/o Vill
Sabilpur Tehsil and District Panchkula State Haryana
134204, India do hereby solemnly affirm and declare
as under:-
1. That I was married to my wife namely KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205 at
Village JAKHRI, Tehsil Panchkula, District Panchkula
State Haryana India 134205, on dated 06-03-2025
according to the Hindu rites and ceremonies in the
presence of guardians and relative of both the
parties.
2. That my date of birth is 04-08-2001.
3. That it is my first marriage and before my marriage.
I was Un-married and I have not again married yet in
India and abroad.
4. That I am aware that if any statement in this
declaration is false and if in making such
statement, I either know or believe it to be false
or do not believe it to be true, I am liable to
imprisonment and also fine.
5. That if any inform in this affidavit found false
later on, the deponent shall be liable to be
prosecuted under section 182 I.P.C.
Deponent
Verification
Verified that all the contents of the above said
affidavit are true and correct to the best of my
knowledge and belief and nothing has been concealed
therein. Action under Section 182 I.P.C. may be
taken if any statement is found false.
Deponent
Verified at ___________
Date ______________
STATEMENT OF HUSBAND
I, JITENDER SHRMA S/O Sh. RAMKARAN R/o R/o Vill
Sabilpur Tehsil and District Panchkula State Haryana
134204, India do hereby solemnly affirm and declare
that my marriage was solemnized with KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205
according to HINDU rites and ceremonies on 06-03-
2025. The marriage was solemnized without any
pressure from anybody who so ever he/she may be and
without giving or taking any dowry. They both were
major on the date of marriage. They have no blood
relation with each other and the particulars
mentioned in the application are correct and true
and nothing has been concealed therein.
RO&AC
AFFIDAVIT
I, KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205 do hereby solemnly affirm and declare
as under:-
1. That I was married to my husband namely JITENDER
SHRMA S/O Sh. RAMKARAN R/o R/o Vill Sabilpur Tehsil
and District Panchkula State Haryana 134204, India
on dated 06-03-2025 according to the HINDU rites and
ceremonies in the presence of guardians and relative
of both the parties.
2. That my date of birth is 12-11-2000
3. That it is my first marriage and before my marriage.
I was Un-married and I have not again married yet in
India and abroad.
4. That I am aware that if any statement in this
declaration is false and if in making such
statement, I either know or believe it to be false
or do not believe it to be true, I am liable to
imprisonment and also fine.
5. That if any inform in this affidavit found false
later on, the deponent shall be liable to be
prosecuted under section 182 I.P.C.
Deponent
Verification
Verified that all the contents of the above said
affidavit are true and correct to the best of my
knowledge and belief and nothing has been concealed
therein. Action under Section 182 I.P.C. may be
taken if any statement is found false.
Deponent
Verified at ____________
Date ______________
STATEMENT OF WIFE
I, KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205 do hereby solemnly affirm and declare
that my marriage was solemnized with JITENDER SHRMA
S/O Sh. RAMKARAN R/o R/o Vill Sabilpur Tehsil and
District Panchkula State Haryana 134204, India at
Village JAKHRI, Tehsil Panchkula, District Panchkula
State Haryana India 134205, according to HINDU rites
and ceremonies on 06-03-2025. The marriage was
solemnized without any pressure from anybody who so
ever he/she may be and without giving or taking any
dowry. They both were major on the date of marriage.
They have no blood relation with each other and the
particulars mentioned in the application are correct
and true and nothing has been concealed therein.
RO&AC
AFFIDAVIT FATHER OF HUSBAND
I, RAMKARAN S/o Ram RATAN R/o Vill Sabilpur Tehsil
and District Panchkula State Haryana 134204, India,
do hereby solemnly affirm and declare as under:-
1- That JITENDER SHRMA is my real son.
2- That my son was married with KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205 on
06-03-2025 at Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205
according to Hindu customs and ceremonies.
3- That this marriage was solemnized with the
consent of both the families.
4- That there is no case or complaint is pending
against this marriage anywhere in India.
5- That my son was unmarried before this marriage.
6- That my son’s date of birth is 04-08-2001.
Deponent
Verification
Verified that the contents of my above affidavit are
true and correct to the best of my knowledge and
belief. I have kept nothing concealed therein.
Date__________________
Place___________________
Deponent
STATEMENT FATHER OF HUSBAND
I, RAMKARAN S/o Ram RATAN R/o Vill Sabilpur Tehsil
and District Panchkula State Haryana 134204, India
do hereby solemnly affirm and declare that my son
JITENDER SHRMA S/O Sh. RAMKARAN R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India has been married with KUMARI ARTI D/O KASHMIRI
LAL Village JAKHRI, Tehsil Panchkula, District
Panchkula State Haryana India 134205 according to
HINDU rites and ceremonies on 06-03-2025 at Village
JAKHRI, Tehsil Panchkula, District Panchkula State
Haryana India 134205. The marriage was solemnized
without any pressure from anybody who so ever he/she
may be and without giving or taking any dowry. They
both were major on the date of marriage. They have
no blood relation with each other and the
particulars mentioned in the application are correct
and true and nothing has been concealed therein.
RO&AC
AFFIDAVIT MOTHER OF HUSBAND
I, PRAMILA DEVI W/o RAMKARAN R/o R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India, do hereby solemnly affirm and declare as
under:-
1- That JITENDER SHRMAis my real son.
2- That my son was married with KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205 on
06-03-2025 at Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205
according to Hindu customs and ceremonies.
3- That this marriage was solemnized with the
consent of both the families.
4- That there is no case or complaint is pending
against this marriage anywhere in India.
5- That my son was unmarried before this marriage.
6- That my son’s date of birth is 04-08-2001.
Deponent
Verification
Verified that the contents of my above affidavit are
true and correct to the best of my knowledge and
belief. I have kept nothing concealed therein.
Date__________________
Place___________________
Deponent
STATEMENT MOTHER OF HUSBAND
I, PRAMILA DEVI W/o RAMKARAN R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India do hereby solemnly affirm and declare that my
son JITENDER SHRMA S/O Sh. RAMKARAN R/o R/o Vill
Sabilpur Tehsil and District Panchkula State Haryana
134204, India, has been married with KUMARI ARTI
D/O KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205
according to HINDU rites and ceremonies on 06-03-
2025 at Village JAKHRI, Tehsil Panchkula, District
Panchkula State Haryana India 134205. The marriage
was solemnized without any pressure from anybody who
so ever he/she may be and without giving or taking
any dowry. They both were major on the date of
marriage. They have no blood relation with each
other and the particulars mentioned in the
application are correct and true and nothing has
been concealed therein.
RO&AC
AFFIDAVIT FATHER OF WIFE
I, KASHMIRI LAL S/o Banarsi Dass R/o Village Jakhri,
Tehsil Panchkula, District Panchkula State Haryana India
134205 do hereby solemnly affirm and declare as under:-
1- That KUMARI ARTI is my real daughter.
2- That marriage of my daughter was solemnized with
JITENDER SHRMA S/O Sh. RAMKARAN R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India on 06-03-2025 at Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 according to Hindu customs and ceremonies.
3- That this marriage was solemnized with the consent
of both the families.
4- That there is no case or complaint is pending
against this marriage anywhere in India.
5- That my daughter was unmarried before this marriage.
6- That my daughter’s date of birth is 12-11-2000.
Deponent
Verification
Verified that the contents of my above affidavit are
true and correct to the best of my knowledge and
belief. I have kept nothing concealed therein.
Dated ------------------
Deponent
STATEMENT FATHER OF WIFE
I, KASHMIRI LAL S/o Banarsi Dass R/o Village
Jakhri, Tehsil Panchkula, District Panchkula State
Haryana India 134205 do hereby solemnly affirm and
declare that the marriage of my daughter namely
KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 has been married with JITENDER SHRMA S/O Sh.
RAMKARAN R/o Vill Sabilpur Tehsil and District
Panchkula State Haryana 134204, India, according to
Hindu rites and ceremonies on 06-03-2025 at Village
JAKHRI, Tehsil Panchkula, District Panchkula State
Haryana India 134205.The marriage was solemnized
without any pressure from anybody who so ever he/she
may be and without giving or taking any dowry. They
both were major on the date of marriage. They have
no blood relation with each other and the
particulars mentioned in the application are correct
and true and nothing has been concealed therein.
RO&AC
AFFIDAVIT MOTHER OF WIFE
I, LAAJWANTI W/o KASHMIRI LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India 134205,
do hereby solemnly affirm and declare as under:-
1- That KUMARI ARTI is my real daughter.
2- That marriage of my daughter was solemnized with
JITENDER SHRMA S/O Sh. RAMKARAN R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India, on 06-03-2025 at Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 according to Hindu customs and ceremonies.
3- That this marriage was solemnized with the consent
of both the families.
4- That there is no case or complaint is pending
against this marriage anywhere in India.
5- That my daughter was unmarried before this marriage.
6- That my daughter’s date of birth is 12-11-2000.
Deponent
Verification
Verified that the contents of my above affidavit are
true and correct to the best of my knowledge and
belief. I have kept nothing concealed therein.
Dated ------------------
Deponent
STATEMENT MOTHER OF WIFE
I, LAAJWANTI W/o KASHMIRI LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 do hereby solemnly affirm and declare that
the marriage of my daughter namely KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205 has
been married with JITENDER SHRMA S/O Sh. RAMKARAN
R/o Vill Sabilpur Tehsil and District Panchkula
State Haryana 134204, India, according to Hindu
rites and ceremonies on 06-03-2025 at Village
JAKHRI, Tehsil Panchkula, District Panchkula State
Haryana India 134205. The marriage was solemnized
without any pressure from anybody who so ever he/she
may be and without giving or taking any dowry. They
both were major on the date of marriage. They have
no blood relation with each other and the
particulars mentioned in the application are correct
and true and nothing has been concealed therein.
RO&AC
JOINT STATEMENT OF BRIDE AND GROOM
We, KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205 and JITENDER SHRMA S/O Sh. RAMKARAN
R/o Vill Sabilpur Tehsil and District Panchkula
State Haryana 134204, India our marriage has been
solemnized according to Hindu rites and ceremonies
on 06-03-2025 at Village Jakhri, Tehsil Panchkula,
District Panchkula State Haryana India 134205 The
our marriage was solemnized without any pressure
from anybody who so ever he/she may be and without
giving or taking any dowry. They both were major on
the date of marriage. They have no blood relation
with each other and the particulars mentioned in the
application are correct and true and nothing has
been concealed therein.
RO&AC
JOINT AFFIDAVIT
We, KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205 and JITENDER SHRMA S/O Sh. RAMKARAN
R/o Vill Sabilpur Tehsil and District Panchkula
State Haryana 134204, India, do hereby solemnly
affirm and declare as under:-
1. That we were both married on dated 06-03-2025
according to the Hindu rites and ceremonies in the
presence of guardians and relative of both the
parties.
2. That our date of birth’s are 12-11-2000 and 04-08-
2001 respectively.
3. That it is our first marriage and before our
marriage. We were Un-married and we have not again
married yet in India and abroad.
4. That we are aware that if any statement in this
declaration are false and if in making such
statements, we either know or believe it to be false
or do not believe it to be true, we are liable to
imprisonment and also fine.
5. That if any inform in this affidavit found false
later on, the deponents shall be liable to be
prosecuted under section 182 I.P.C.
Deponents
Verification
Verified that all the contents of the above said
affidavit are true and correct to the best of our
knowledge and belief and nothing has been concealed
therein. Action under Section 182 I.P.C. may be
taken if any statement is found false.
Deponents
STATEMENT OF WITNESS
I, Neeraj SHRMA S/o Dharm Pal R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India, do hereby solemnly affirm and declare that
JITENDER SHRMA S/O Sh. RAMKARAN R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
has been married with KUMARI ARTI D/O KASHMIRI LAL
Village JAKHRI, Tehsil Panchkula, District Panchkula
State Haryana India 134205 according to Hindu rites
and Ceremonies on 06-03-2025 at Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205.The marriage was solemnized without any
pressure from anybody who so ever he/she may be and
without giving or taking any dowry. They both were
major on the date of marriage. They have no blood
relation with each other and the particulars
mentioned in the application are correct and true
and nothing has been concealed therein.
RO&AC
Affidavit of witness
I, Neeraj SHRMA S/o Dharm Pal R/o Vill Sabilpur
Tehsil and District Panchkula State Haryana 134204,
India, do hereby solemnly affirm and declare as
under:-
1- That JITENDER SHRMA S/O Sh. RAMKARAN R/o Vill
Sabilpur Tehsil and District Panchkula State Haryana
134204, has been married with KUMARI ARTI D/O
KASHMIRI LAL Village JAKHRI, Tehsil Panchkula,
District Panchkula State Haryana India 134205
according to Hindu rites and Ceremonies on 06-03-2025
at Village JAKHRI, Tehsil Panchkula, District
Panchkula State Haryana India 134205..
2- That this marriage was solemnized with their mutual
consent
3- That I was present at the time of this marriage.
4- That there is no case or complaint is pending
against this marriage anywhere in India.
Deponent
Verification
Verified that the contents of this affidavit are
true and correct to the best of my knowledge and
belief and nothing has been concealed therein.
Verified at Shahzadpur ____________
Deponent
STATEMENT OF WITNESS
I, MUKESH KUMAR S/O PIARE LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 do hereby solemnly affirm and declare that
KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 has been married with JITENDER SHRMA S/O Sh.
RAMKARAN R/o Vill Sabilpur Tehsil and District
Panchkula State Haryana 134204 according to Hindu
rites and Ceremonies on 06-03-2025 at Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205.. The marriage was solemnized without
any pressure from anybody who so ever he/she may be
and without giving or taking any dowry. They both
were major on the date of marriage. They have no
blood relation with each other and the particulars
mentioned in the application are correct and true and
nothing has been concealed therein.
RO&AC
Affidavit of witness
I, MUKESH KUMAR S/O PIARE LAL Village JAKHRI, Tehsil
Panchkula, District Panchkula State Haryana India
134205 do hereby solemnly affirm and declare as
under:-
1- That KUMARI ARTI D/O KASHMIRI LAL Village JAKHRI,
Tehsil Panchkula, District Panchkula State Haryana
India 134205, has been married with JITENDER SHRMA
S/O Sh. RAMKARAN R/o Vill Sabilpur Tehsil and
District Panchkula State Haryana 134204, according
to Hindu rites and Ceremonies on 06-03-2025 at
Village JAKHRI, Tehsil Panchkula, District Panchkula
State Haryana India 134205..
2- That this marriage was solemnized with their mutual
consent
3- That I was present at the time of this marriage.
4- That there is no case or complaint is pending
against this marriage anywhere in India
Deponent
Verification
Verified that the contents of this affidavit are
true and correct to the best of my knowledge and
belief and nothing has been concealed therein.
Verified at Naraingarh ____________
Deponent
