Application for a Marriage Certificate
For Register Office Use Only
Register No.
Entry No.
Certificate No.
Date of issue
1. To be completed by the person applying for the certificate
Mr
Your full name:
Mrs
Miss/Ms
Address:
(Including Post Code)
Telephone – Mobile:
Telephone - Home:
2.
Please state the purpose for which the certificate is required.
3. Details of Marriage Certificate Required
Party 1
Party 2
Full name (on day of marriage)
Any other surnames used before this
marriage
Full name (on day of marriage)
Any other surnames used before this
marriage
Father’s full name
Father’s full name
Place of marriage (Name of building, church or registration office)
Date of marriage
4. Requirements
I require
marriage certificate(s)
(number)
5. Remittance Enclosed
I enclose a cheque/postal order for £
a stamped addressed envelope.
(made payable to 'Superintendent Registrar') together with
6.
Signature: …………………………………………….. …….
Date:………………………………………..