Zm{eH$ _hmZJanm{bH$m, Zm{eH$

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Form D

Memorandum of Marriage
(nhm H$c_ 6 Am{U {Z`_ 5)
[See section 6 and Rule 5]

1.

{ddmhmMm {XZmH$

1.

Date of Marriage :

2.

{ddmhmMo {R>H$mU
(gnwU Vn{ecmgh)

2.

Place of Marriage
(With Full Particulars)

3.

njH$mam_Yrc {ddmh `m `VrJV

H$m`md`o {dYr gnZ Pmcm

3.

Personal Law according to which the

Marriages between the parties was solemnized

4.

(A) nVrMo Zmd

(W_ AmS>Zmdmgh nyU Zmd)

4.

(a)

Name of Husband

(Full Name beginning with surname)

(~) nVrcm Xwg`m ZmdmZo (H$moUVohr Agmo)

AmoiIV Ag`mg Vo Zmd / Vr Zmdo
(b)

Other Name /s (if any) by which

The Husband is know

(H$) Y_

(EH$) O_mZo

(c)

(i) By Birth

Religion

(XmoZ) Xwgam Y_ pdH$macm

Ag`mg (H$moUVmhr Ag`mg)
(ii) By adoption (if any)

(S>) {ddmh {dYr `m VmaIog gnZ

df

_{hZm

Year

Months

Pmcm Agoc `m VmaIog Agcoco d`

(d)

Age as on the date of solemnization

of marriage

(B>) `dgm` H$m`mc`m`m n`mgh

(e)

Occupation along with office address

(\$) {ddmhm`m doiMr pWVr

A{ddm{hV/{dYwa/KQ>\$mo{Q>V

(e)

Unmarried/Widower/Divorced

Status at the time of Marriage

(J) nVrMm nyU nVm

(g)

Full address of the husband

(h) nVrMr {XZmH$mgh ghr

(h)

Signature of the husband with date

5. (A) nZrMo Zmd (cmnwduMo Zmd)

W_ AmS>Zmdmgh nyU Zmd
5.

(a) Name of the Wife (Maiden Name)

Full Name beginning with surname

(~) nZrcm Xwg`m ZmdmZo (H$moUVohr Ag`mg)

AmoiIV Ag`mg Vo Zmd/Zmdo
(b) Other Name/ s [if any] by
Which the wife is known

(H$)Y_

(EH$) O_mZo

(c) Religion

(i) By Birth

(XmoZ) Xwgam Y_ pdH$macm

Ag`mg (H$moUVmhr Ag`mg)
(ii) By adoption (if any)

(S>) {ddmh {dYr `m VmaIog gnZ

df

_{hZm

Year

Months

Pmcm Agoc `m VmaIog Agcoco d`

(d) Age as on the date of solemnization
of marriage

(B) {ddmhm`m doiMr pWVr

A{ddm{hV/{dYwa/KQ>\$mo{Q>V

(e) Status at the time of Marriage

Unmarried/Widower/Divorced

(\$) {ddmhm`m nydu`m AWdm

{ddmhm`m doiMm nZrMm
nyU nVm
(f) Full address of the wife before or
at the time of marriage

(J) nZrMr {XZmH$mgh ghr

(g) Signature of the wife with date

6. gmjrXma1) (EH$) Zmd

(1) (I)

Name

(XmoZ) nVm
(ii)

Address

(VrZ) `dgm` Am{U H$m`mc`mMm nVm

(iii) Occupation and Office Address

(Mma) {ddm{hV OmoS>`mer Agcoco ZmVo

(H$moUVohr Ag`mg)
(iv) Relation (if any)
with the marriage couple

(nmM) {XZmH$mgh ghr

(v) Signature with date

gmjrXma

2) (EH$) Zmd
(1) (I)

Name

(XmoZ) nVm
(ii)

Address

(VrZ) `dgm` Am{U H$m`mc`mMm nVm

(iii) Occupation and Office Address

(Mma) {ddm{hV OmoS>`mer Agcoco ZmVo

(H$moUVohr Ag`mg)
(iv) Relation (if any)
with the marriage couple

(nmM) {XZmH$mgh ghr

(v) Signature with date

gmjrXma 2) (EH$) Zmd

(1) (I)

Name

(XmoZ) nVm
(ii)

Address

(VrZ) `dgm` Am{U H$m`mc`mMm nVm

(iii) Occupation and Office Address

(Mma) {ddm{hV OmoS>`mer Agcoco ZmVo

(H$moUVohr Ag`mg)
(iv) Relation (if any)
with the marriage couple

(nmM) {XZmH$mgh ghr

(v) Signature with date

nwamo{hV

(EH$) nwamo{hVmMo Zmd

(I)

Name of the priest (if any)

(XmoZ) nwU nVm

(ii) Full Address

(VrZ) Y_
(iii) Religion

(Mma) d`
(iv) Age

(nmM) {XZmH$mgh ghr

(v) Signature with date
8.

`m kmnZmgh gmXa Ho$coco XVEodO

8.

Document Presented alongwith this memorandum

1)
a)

2)
b)

3)
c)

4)
d)

9.

{Z~YH$mH$S>o gmXa Ho$`mMm {XZmH$

9.

Presented before the registrar on Date

/200
/

/ 200

Q>rn H$moU`mhr `VrZo kmnZm_`o Ho$coco H$moUVohr {dYmZ AWdm {VkmnZ Oo {deof _hdmMo ~m~VrV ImoQ>o Agoc AWdm gmXa
Ho$coco H$moUVohr XVEodO Oo ImoQ>o Ag`mMo `mcm / {Vcm _m{hV Agoc AWdm Oo ImoQ>o Ag`mMo _mZ`mg H$maU Agoc, Vmo/ Vr
`Vr H$c_ 12 Imcr XS>Zr` H$madmBg nm R>aoc.

N.B. Any person making any statement of declaration in the memorandum, which is false in any material particular of
submits any documents which he/she know or has reason to believe to be false shall be liable for penal action under
section 12.

gXaMr {dkVr _hmam> {ddmh _S>imMo {d{Z`_Z Am{U {ddmh A{Y{Z`_mMo Zm|Xdhr`m IS>
IS> H$_mH$

`m nR>H$_mH$

da

H$_mH$ {XZmH$

/ 20

amoOr

Zm|Xco
{R>H$mU Zm{eH$
{XZmH$

{ddmh {Z~YH$ Zm{eH$ - 1

This Memorandum is registered at Serial No.

Page No.

on
of Volume No.

on

/ 200

of register of Marriages maintained under the Maharashtra Regulation of Marriage

Bureaus and Registration of Marriages Act, 1988.
Place : Nashik
Date :

/ 20

Registrar of Marriages, Nashik - 1

xE xM{E, xE
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