Certificate of Marriage Celebrated in other Forms

(See section 16)

I, ………………………………..………., hereby certify that ……………….. and ………………... appeared before me this ………………….. day of ………….. 20…………. and that each of them, in my presence and in the presence of three witnesses who have signed hereunder have declared that a ceremony of marriage has been performed between them and that they have been living together as husband and wife since the time of their marriage and that in accordance with their desire to have their marriage registered under this Act, the said marriage has this …….……………….. day of …………….. 20……… been registered under this Act, having effect as from …………………..

(Sd.) 
………………….
Marriage Officer for
(Sd.) 
……………………
Husband
(Sd.) 
………………….
Wife
(Sd.) 
							………………
(Sd.) 
						……………….
							(Sd.) 
							……………….
Dated the ………………………… day of ………………. 20…………