Annex A - Marriage Certificate

Municipal Form No. 97 (Form No. 13) (Revised January 1993)

(To be accomplished in quadruplicate)

REMARKS/ANNOTATION

Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL

CERTIFICATE OF MARRIAGE Iloilo

Province City/Municipality

Registry No. (HUSBAND)

Name of Contracting Parties

1234

Jaro, Iloilo City

(first)

(middle initial)

Juan Gregory

(day) Date of Birth/Age

1

Acosta

(month)

(last)

dela Cruz

(year)

January

(WIFE)

1993

(age) 18

(first)

FOR OCRG USE ONLY:

(middle initial)

Maria Caressa

(day)

Mendoza

(month)

1

Santos

(year)

(age)

1993

18

January

Population reference No.

(last)

(Husband)

(Wife)

21 Barangay Mohon, Arevalo, Iloilo City

Place of Birth

Sex (Male or Female

Barangay Calumpang, Molo, Iloilo City

Male

Female

Citizenship

Filipino

Filipino

Residence

Barangay Mohon, Arevalo, Iloilo City

TO BE FILLED UP AT THE OFFICE OF THE CIVIL REGISTRAR 80

Barangay Calumpang, Molo, Iloilo City 87

Religion

Roman Catholic

Roman Catholic

Single

Single

Civil Status (first)

Juan

Name of Father Citizenship

(middle Initial) (last) Sevilla

(first)

dela Cruz

Mario

(middle Initial)

(first)

Christine

90

92

93

(last)

dela Vega Santos

Filipino

Name of Mother

88

Filipino

(middle Initial) (last)

Angeles

(first)

Abby

Acosta

(middle Initial)

Bartolome

(last)

Mendoza 94

Citizenship

Filipino (first)

Persons who gave consent or advice

Juan Christine

Filipino

(middle Initial) (last)

Sevilla Angeles

(first)

dela Cruz Acosta

Father/Mother

Relationship

Place of Marriage

(last)

dela Vega Bartolome

Santos Mendoza

Father/Mother

Barangay Mohon, Arevalo, Iloilo City

Residence

(middle Initial)

Mario Abby

104

105

106

107

Barangay Calumpang, Molo, Iloilo City

Jaro Cathedral, Jaro, Iloilo City, Philippines

…………………………………………………………………………… (Office of the/House of/Barangay of/Church of/Mosque of) ………………………………………………………………………………………………. 1 March 2010

Date:

99

Address

………………………………….. (day) (month) (year)

108

11:40 am

Time:……………………………..

Juan Gregory dela Cruz

THIS IS TO CERTIFY: That I ………………………………………………………………………………………….. Maria Caressa Santos and I, ………………………………………………………………………………………..………….., both of legal age, of our own free will and accord, and in the presence of the person solemnizing this marriage and of the witnesses named below, take each other as husband and wife and certifying further that we:

113

have not entered into marriage settlement. 119



have entered into a marriage settlement, a copy of which is hereto attached.

10th

IN WITNESS WHREOF, we signed/marked with our finger print, this certificate in quadruplicate this……………. day of ………………………………….. , …………………… March 2010 RECEIVED AT THE OFFICE OF THE CIVIL REGISTRAR ………………………………………………………………. (Signature of Husband)

……………………………………………………… (Signature of Wife)

THIS IS TO CERTIFY: THAT BEFORE ME, on the date and place above-written, personally appeared the aboveMentioned parties, with their mutual consent, lawfully joined together in marriage which was solemnized by me in the presence of the witnesses named below, all of legal age. I CERTIFY FURTHER THAT:

 

10 March 2010

Marriage License No. …………………………. Issued on ………………………………………...…, at …………………………………………………….in favor of said parties, was exhibited to me. Jaro, Iloilo CIty No marriage license was necessary, the marriage being solemnized under Art ……………of Executive Order No. 209. The marriage was solemnized in accordance with the provisions of Presidential Decree No. 1083 ………………………………………………………………………………. (Signature of Solemnizing Officer)

……………………………………………………….. (Position/Designation) ………………………………………………………………………………………………………………………………………... (Religious Affiliation, Registry No. and Expiration Date, if applicable) WITNESSES (Print Name and Sign) ……………………………………………… …………………………………………………… ………………………………………………

Name in Print Title or Position

1234



Signature

…………………………………………………….

Date Received

OATH OF SOLEMNIZING OFFICER

I,

Antonio Montelibano

, solemnizing officer, do solemnly swear:

That I have ascertained the qualifications of the contracting parties and have found nolegal impediment for them to marry as required by Art. 34 of the Family Code;

That this marriage was performed in articulo mortis; That the residence of one or both of the contracting parties: barangay/barrio/sitio (and) is so located that there is no means of transportation to enable the concerned party/parties to appear personally before the civil registrar; That the marriage was among Muslims or among members of the ethnic cultural communities, provided the marriage was solemnized in accordance with their customs or practices; And that I took the necessary steps to ascertain the ages and relationships of the contracting Parties and that neither of them are under any legal impediment to marry each other. Antonio Montelibano

……………………………………… Signature of Solemnizing Officer

SUBSCRIBED AND SWORN to before me this who exhibited to me his Community Tax No. at Jaro, Iloilo CIty

1234

10th

day of

March

issued on

,

,

1 January 2019

.

Antonio Montelibano Signature over Printed Name of Administering Officer 30 December 2022 whose Commission Expires on Doc. No. Page No. Book No. Series of

NOTE – In case of a marriage on the point of death, when the dying party, being physically unable, cannot sign the Instrument by signature or mark, it shall be sufficient for one of the witnesses to the marriage to sign in his name, which in fact shall be attested by the person solemnizing the marriage as follows: I HEREBY CERTIFY that the contracting party ………………………………………………………….. being on the point of death and physically unable to sign the foregoing marriage contract by signature or mark, one of the witnesses to the marriage signed fro him or her by writing the dying party’s name and beneath it, the witness’ own signature preceded by the preposition ‘By’.

Antonio Montelibano …………………………………………………….. . Signature and Printed Named of Solemnizing Officer