SCHEDULE

FORM – A

( Issued under the Provisions of Section 12 of Telanagana Compulsory Registration of Marriage Act,2002)

MARRIAGE CERTIFICATE

Certificate No. Date :

I hereby certify that I have registered under the Telangana Compulsory

Registration of Marriage Act,2002 the marriage of bridegroom __________________________

with bride __________________________________________________ on this ____________

day of 2019 in pursuance of the memorandum dated the day of _______________________

received by me and the same has been entered as serial No. ________________ In page _______

of the Register of Marriage maintained by me for the year __________________

Marriage Officer / Panchayat Secretary

Gram Panchayat ________________

With Reference to :

1. G.O Ms No. 16 Dept.for WCD & SC, Dated: 23.12.2014 Adaption of A.P Compulsory
Marriage Registration of Act to State of Telangana.
2. G.O Ms.No. 19 Dept.for WCD&SC, Dated : 31.12.2014 for appointing Panchayat
Secretaries as Marriage Officers in Gram Panchayats.
 MEMORANDUM OF MARRIAGE

( See Section 8 of Telangana Compulsory Registration of Marriage Act-2002)

1. Date of Marriage
2. Place of Marriage
(With Sufficient Particulars to Locate the Place)

Photograph
Photograph
of the Bride
of the
Bridegroom

Photograph of the Bridegroom Photograph of the Bride

DECLARATION: We hereby declare that the marriage was performed with our consent
and that to our knowledge our marriage was not barred by any law in force at the time of
our marriage. I further declare that that all information furnished by us herein is correct.

Signature of Bridegroom Signature of Bride

Bridegroom Particulars
3. (a ) Full Name of the Bridegroom
( b) Father Name / Mother Name
( c) His age at the time of Marriage
(d) Usual Place of Residence
(e) Address
(f) Status of the bridegroom at the time of
Marriage ( Unmarried / Widower / Divorced )
: ____________________________
: ____________________________
: ____________________________
: ____________________________
: ____________________________
: ____________________________

WITNESSES
1. (a) Name : ____________________________
(b) S/O , W/O, D/O : ____________________________
(c) Age : ____________________________
(d) Usual Place of residence : ____________________________
(e) Address : ____________________________

Signature of Witness
2. (a) Name : ____________________________
(b) S/O , W/O, D/O : ____________________________
(c) Age : ____________________________
(d) Usual Place of residence : ____________________________
(e) Address : ____________________________

Bride’s Particulars
4. (a ) Full Name of the Bride
( b) Father Name / Mother Name
( c) Her age at the time of Marriage
(d) Usual Place of Residence
(e) Address
(f) Status of the bridegroom at the time of
Marriage ( Unmarried / Widower / Divorced )
Signature of Witness
: ____________________________
: ____________________________
: ____________________________
: ____________________________
: ____________________________
: ____________________________

WITNESSES
3. (a) Name : ____________________________
(b) S/O , W/O, D/O : ____________________________
(c) Age : ____________________________
(d) Usual Place of residence : ____________________________
(e) Address : ____________________________

Signature of Witness
4. (a) Name : ____________________________
(b) S/O , W/O, D/O : ____________________________
(c) Age : ____________________________
(d) Usual Place of residence : ____________________________
(e) Address : ____________________________

Signature of Witness