Report Of Marriage Of A Philippine Citizen Abroad Form

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NOT FOR SALE

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FOREIGN AFFAIRS

Form Prescribed by FSC 75-94

(REVISED JUNE 2013)

DATE OF REPORT

REPORT OF MARRIAGE

(day-month-year)

OF A PHILIPPINE CITIZEN ABROAD

THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE

Foreign Service Post:

PARTICULARS OF CONTRACTING PARTIES

HUSBAND

WIFE

1. LAST NAME

2. FIRST NAME

3. MIDDLE NAME

4. DATE OF BIRTH

(day-month-year)

5. AGE

6. PLACE OF BIRTH

7. CITIZENSHIP

8. RESIDENCE

9. CIVIL STATUS

[ ] SINGLE [ ] DIVORCED

[ ] WIDOW/WIDOWER

[ ] SINGLE [ ] DIVORCED

[ ] WIDOW/WIDOWER

10. RELIGION

11. OCCUPATION

12. FATHER'S FULL NAME

13. CITIZENSHIP

14. MOTHER'S FULL NAME

15. CITIZENSHIP

16. NAME OF WITNESS 1

17. RESIDENCE

18. NAME OF WITNESS 2

19. RESIDENCE

20. DATE OF MARRIAGE

21. PLACE OF MARRIAGE

22. NAME OF SOLEMNIZING/ OFFICIATING OFFICER

23. TITLE OF SOLEMNIZING/ OFFICIATING OFFICER

We/I solemnly swear under penalty of law that the statements made on this report are true and correct, and the attached supporting documents are authentic; and we/I

hereby set our hand/s this ___________ day of ________________________________ at ________________________________________________________________.

Signature of Husband: _____________________________________________________

Signature of Wife: ____________________________________________

EMBASSY/CONSULATE OF THE REPUBLIC OF THE PHILIPPINES

The marriage was today registered with the Embassy/ Consulate under No. ___________________________ of the Civil Registry Book. This report has been executed in a

quadruplicate, copy furnished the contracting parties, copy transmitted to the Department of Foreign Affairs (DFA) in Manila, copy transmitted to the Civil Registrar

through the DFA, and copy places in the files of this Embassy/Consulate together with the following supporting documents:

[ ] MARRIAGE CERTIFICATE

[ ] COPIES OF PASSPORTS OF CONTRACTING PARTIES

Date : _____________________

Doc. No. ___________________

Service No. _________________

O.R. No. ____________________

Fee Paid ___________________

Book No. ___________________

SEAL

REPUBLIC OF THE PHILIPPINES

Series of ___________________