Key No. FORM No.

IV
M0179WB09012019001000 [See Rule 11(1)]
GOVERNMENT OF KERALA
DEPARTMENT OF URBAN AFFAIRS
CERTIFICATE OF MARRIAGE
[ Issued under rule 11 (1) of the Kerala Registration of Marriages (Common) Rules, 2008 ]

Certificate No. 397/2019 Dated. 16/11/2021

This is to certify that the following information has been taken from the Register of Marriages (Common) maintained in Form No. III
in the Office of the Local Registrar of Thiruvalla Municipality

1. Date of Marriage : 29/11/2018

2.Place of Marriage : St. Thomas Evangelical Church of India, Central Chapel, Manjadi

Kavumbhagom Village, Thiruvalla Taluk, Pathanamthitta District

3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife

(a) Name in full (Capital Letters) JOBIN SHAJI JOHN NIKITA DAMBALE

(b) Nationality Indian Indian

(c) Age and date of birth 32, 11/07/1986 27, 16/05/1991

(d) Occupation Banking Store In Charge

(e) Permanent Address s/o Shaji John, 00, AT-Masoli Post- d/o Subhash Dambale, 6, Sister Quarter No 6,
Chandranagar, Behind Ambica Gas Agency, Mure Memorial Hospital Campus, Nagpur City,
Dahanu Road, Thane , Maharashtra - 401602 Sitabuldi, Nagpur, Nagpur , Maharashtra -
440001

(e.a) where the husband is a Non - resident

Indian
(i) Address NA

(ii) Security Number NA

(iii) Passport Number NA

(f) Name of parents or guardian and the

relationship
(i) Father John Shaji Johny Subhash Damodhar Dambale

(ii) Mother John Jessy Shaji Anitha Mary Subhash Dambale

(ii) Guardian

This certificate is computer generated and does not require any Seal/Signature in original.
The Govt. vide G.O.(P) 6/2013/Law Dated 09/10/2013 has approved this certificate as a valid document for all official purposes
The authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
Page 1/2
Key No.
M0179WB09012019001000
3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife

(g) Photographs:

Registration No. 23/2019 Date of Registration : 10/01/2019

Date of Issue : 16/11/2021 (12:15)

: Sixteenth Day of November 2021

Last Updated on 10/01/2019 (17:38) Local Registrar : Local Registrar of Marriages (Common) ,
Thiruvalla Municipality

This certificate is computer generated and does not require any Seal/Signature in original.
The Govt. vide G.O.(P) 6/2013/Law Dated 09/10/2013 has approved this certificate as a valid document for all official purposes
The authenticity of this certificate can be verified at www.cr.lsgkerala.gov.in. The Key Number is unique to each event.
Software developed and supported by Information Kerala Mission.
Certificate printed before the last updated date is invalid
Page 2/2