THIS FORM IS NOT FOR SALE

Republic of the Philippines

National Statistics Office
OFFICE OF THE CIVIL REGISTRAR GENERAL
APPLICATION FORM - MARRIAGE CERTIFICATE
IMPORTANT : PLEASE READ GENERAL INSTRUCTION BEFORE FILLING UP THE FORM
Gen.Instruct:Please PRINT letters in the spaces provided. Please CHECK (a) appropriate box(es)
Request for : MARRIAGE CERTIFICATE AUTHENTICATION CDLI

Number of copies: One Two Others (Specify) : __________

Birth Reference No. of Husband - - -

BReN (if known)

Birth Reference No. of Wife - - -

BReN (if known)
NAME OF HUSBAND
Last Name

First Name

Middle Name

Husband's Tax Identification No.(TIN) - -

(if known)
MAIDEN NAME OF WIFE

Last Name

First Name

Middle Name

Wife's Tax Identification No.(TIN) - -

(if known)

DATE OF MARRIAGE
MONTH DAY YEAR

PLACE OF MARRIAGE
City / Municipality

Province

Please specify country if

married abroad only:
Country
REGISTERED LATE? No Yes When:
Check (a) appropriate box

PLEASE TURN TO BACK PAGE

FOR NSO USE ONLY

TRANSACTION NUMBER :
PURPOSE : Choose one and check (a) appropriate box
Claim Benefits / Loans Employment (Local) School Requirement

Passport / Travel (Specify Country: _______________ ) Others (Specify) :

_____________________
Employment (abroad) (Specify Country: _______________ )

REQUESTER'S INFORMATION
Last Name , First Name ,MI

Mailing Address
House No. Street Name / Barangay
City / Municipality

Province

Tel. No.

FOR NSO USE ONLY

MONTH DAY YEAR Converted ? Y N

Date of Filing / / 20
For CDLI request only:
Date of Release / / 20 CDLI type : _______________________
Remarks : Proper : _________ pages
Attachment : _________ pages

Received by : _____________________________________ Date of receipt : ____________________

THIS FORM IS NOT FOR SALE