I, A.B., hereby declare as follows:―

1. I am at the present time unmarried (or a widower or a divorcee, as the case may be).

2. I have completed .....years of age.

3. I am not related to C.D. (the bride) within the degrees of prohibited relationship.

4. 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 to fine.

(Sd.) A.B. (the Bridegroom).

DECLARATION TO BE MADE BY THE BRIDE

I, C.D., hereby declare as follows:―

1. I am at the present time unmarried (or a widow or a divorcee, as the case may be).

2. I have completed ....years of age.

3. I am not related to A.B. (the Bridegroom) within the degrees of prohibited relationship.

4. 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 to fine.

(Sd.) C.D. (the Bride).

Signed in our presence by the above-named A.B. and C.D. So far as we are aware there is no lawful impediment to the marriage.

(Sd.) G.H. Three witnesses.

(Sd.) I.J.

(Sd.) K.L.

Countersigned E.F.,

Marriage Officer

Dated the day of 20