Registry No.

____________________
Date of Receipt __________________
Date of Issuance of Marriage License ________________________

&LW\Form No. 90 (Form No. 2)

(Revised January 1993)
APPLICATION FOR MARRIAGE LICENSE
The Civil Registrar The Civil Registrar
City of __________________________________________ City of __________________________________________
Province of __________________________________________ Province of __________________________________________

Sir/Madam: Sir/Madam:
May I apply for a license to contract marriage with May I apply for a license to contract marriage with
___________________________________________a ___________________________________________a
nd to this effect, being duly sworn, I hereby depose and say nd to this effect, being duly sworn, I hereby depose and say
that I have all the necessary qualifications and none of the that I have all the necessary qualifications and none of the
legal disqualifications to contract the said marriage and that legal disqualifications to contract the said marriage and that
the following data are true and correct to the best of my the following data are true and correct to the best of my
knowledge and information: knowledge and information:
(First) (Middle) (Last) Name of (First) (Middle) (Last)
Applicant
(Day) ( Month) (Year) (Age) Date of (Day) ( Month) (Year) (Age)
Birth/Age
(City) (Province) Place of Birth (City) (Province)

Sex (Male of
Female)
Citizenship
Residence
Religion
Civil Status
IF
PREVIOUSLY
MARRIED:
How was it
dissolved
(City) (Province) Place where (City) (Province)
dissolved
(Day) (Month) (Year) Date when (Day) (Month) (Year)
dissolved
Degree of
Relationship of
contracting
parties
(First) (Middle) (Last) Name of (First) (Middle) (Last)
Father
Citizenship
Residence
(First) (Middle) (Last) Name of (First) (Middle) (Last)
Mother
Citizenship
Residence
(First) (Middle) (Last) Persons who (First) (Middle) (Last)
gave consent
or advice
Relationship
Citizenship
Residence

________________________________ ________________________________
(Signature of Applicant) (Signature of Applicant)

Exempt from
SUBSCRIBE AND SWORN to before me this Documentary
SUBSCRIBE AND SWORN to before me this
_______________ day of __________, __________at _______________ day of __________, __________at
stamp tax
___________________________________________ ___________________________________________
__________________________________, Philippines. __________________________________, Philippines.

_______________________________________________________ _______________________________________________________
(Signature over printed name of the Civil Registrar) (Signature over printed name of the Civil Registrar)