THE THIRD SCHEDULE
{See Section 11oi the special Marriage A.t}
lSri
&esidenl of
hereby declare as follows;
1. I am at the pre$ent time unmarried {or a widower or a divorcee, a5 the case may be }
2. i have compleied years of age.
3. I am not related to
{the bride}within the degrees of prohibited relationship.
4. I anr aware that, if any statemert in this declaration is false, and if in making such ,latement I
either know or believe it to be false or.io not believe it !o be true, I am liable to imprisonment and
also to fine.
Signature of Eridegroom
l, smt.
Resident o{
hereby declare as {ollows:
1. I am al the presenl lims lnmarried {or a widower orc divorcee, a: the case may be }
?. I lave completed years ofage.
3. I am rot related to
(the bridegmomlwithin the degrees of prohibiled relationship.
4. I am aware that, if any statement in this dec,a.ation is false. and if ln making such statement I either
know or beli€ve it to be false or do not believe il to be true, I am liable to imprisonment and alto to
tin6.
Signature of the bride
Sigred in our presence by the obave named
As far as we qware thqt ther€ is na lowful impediment to the marfiale
WiUless:
7. Nome
s/a
Address:
P. Name
s/a
Addrest:
3. Ndme
s/o
Address:
Coinaersig*ed
Manisge otltcer
A]{*Exrrt&tl
13.. .!ctloE 5l
rsrlcE OF IXTDIIITED MrrnnlAcE
f0 i:
DiElricl' Ass{rn'
The Mardagc (Xfic6t for thc--.,.-...'.. . - " " ''
'-
w4 hercby gilc ,!u oot ce lhat a malliagp qndct rh' sp'eial [46rtiage Act' 1954' i8 isrcfldtd to bc 6olemtlistd
l"t*."r, is-wi*rio three Cal(fldar morihs ft rn lhc date lhel.e'l
I{ame a.od l?ahca'o Nama
Condition
Cccupalion
as ('Y.ars)
-e3t.( Dwel:t$g Piace
};aai':.nr dwcliing place itpres€nt dstclli&g pla.a i8 not perna$c'lt
ir.grh ot.cad€nc. at the pres.nt dwslling plaee
sRIDEGROOM
s1o.........,...
U$marrild/ Wrdo. 'crl Divorcec
Age
vilt-........,.
P.0...,,.....,..,...
P.S..... ^,...,..-...
Dist,.....,....,....
Length of resid.nce st rttd presant dq,elting place
Signatuac of BrideSroom
BRIOE
Sri............,.-....,.. .-
D/o.............'-..-.
Atc
Yll!..-.........-....-.
P.O.....,-.........
P S.... ... ....
Di$t............,.,.,.....,...
UnInarfiedl Widow lDitorNee
Length ot restdcncc a! tbe ptasent d\rellidg ple.ce
Signatute of Bridc
Merha No.,..........-....,..-. . ....... ..., ,Aan"-A
Capb Ian,)r\lded to lhe Mamage Olfer"-.. . .
. .- ....,.L11S 6{3} of rhc Special MarriaSe Act, 1954.
Manlat. Olficer
Wltnessollr ...... ..Thlsd6Y. .-.....
A\Nl,Xl_JRB"lV
Intended Marriage
OATH
take th. Smri...
da ughter of ....... ...
resident ol...
a, my lawf!, wife from
Dale
P1ace....................... (Namc in Capital Ldter)
Ds ughter
Residert of.
take rhe Sri............ ...
Son of ...... ....-.... ...
rBidert of ...... -.....
as my lawiul husband from today.
Signat$re..
Bride
P1ace..,.."................- (Name in Capital Letrer)
