Key No. FORM No.

IV
M1155WB07092017004000 [See Rule 11(1)]
GOVERNMENT OF KERALA
DEPARTMENT OF PANCHAYATH
CERTIFICATE OF MARRIAGE
[ Issued under rule 11 (1) of the Kerala Registration of Marriages (Common) Rules, 2008 ]

Certificate No. 4065/2017 Dated. 12/04/2020

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 Panniyannur Grama Panchayat

1. Date of Marriage : 13/08/2017

2.Place of Marriage : Rose Mahal

Panniyannur Village, Thalassery Taluk, Kannur District

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

Details Husband Wife

(a) Name in full (Capital Letters) SHABEER THAVARA KATTIL FATHIMA SHIRIN MOILOTH
RANDUPURAYIL
(b) Nationality Indian Indian

(c) Age and date of birth 26, 30/11/1990 23, 01/05/1994

(d) Occupation Business Nil

(e) Permanent Address Rose Mahal, Champad, Champad, Kannur, M R House, Paral, Kuthuparamba, Kannur,
Kerala - 670694 Kerala - 670643

(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 Abdulla Namath Poyil Moidu Thoppil Puthiyapurayil

(ii) Mother Arifa Thavara Kattil Laksana Moiloth Randupurayil

(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.
M1155WB07092017004000
3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife

(g) Photographs:

Registration No. 104/2017 Date of Registration : 19/09/2017

Date of Issue : 12/04/2020 (17:49)

: Twelfth Day of April 2020

Last Updated on 19/09/2017 (13:49) Local Registrar : Local Registrar of Marriages (Common) ,
Panniyannur Grama Panchayat

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