EMBASSY OF THE REPUBLIC OF THE PHILIPPINES

APPLICATION FOR A CERTIFICATE OF LEGAL CAPACITY

TO CONTRACT MARRIAGE
TO:

EMBASSY OF THE PHILIPPINES

CONSULAR SECTION
KUALA LUMPUR, MALAYSIA

I have the honor to apply for a Certificate of Legal Capacity to Contract Marriage, and hereby
declare that:
1.
2.

My full name is ____________________________________________________

My personal details are as follows:
2.1
Age: _______ 2.2 Date of Birth ______________________________
2.3
Sex: _______ 2.4 Place of Birth ______________________________

3.
4.

My present occupation is ____________________________________________

I am presently residing at (address in Malaysia) __________________________
________________________________________________________________
My permanent address in the Philippines is _____________________________
________________________________________________________________
The name of the person I intend to marry is _____________________________
________________ of (Country/nationality) ____________________________
My fathers full name is _____________________________________________
He is presently residing at ___________________________________________
My mothers full name is ____________________________________________
She is presently residing at __________________________________________
I further certify that I am (single/widow/widower) _________________________
_________ and that I do not possess any legal impediment to contract marriage under
the laws of the Philippines; and
That I am executing this affidavit with the knowledge of the legal
Consequences of my statement in support of my application for
certificate of legal capacity to contract marriage.

5.
6.
7.
8.
9.

10.

IN WITNESS WHEREOF, I hereby affixed my signature this ______ day of ________

______________________ 20___

____________________________
(Signature)
Telephone No.: _______________
Passport No.: __________________
Date of Issue : _________________
Place of Issue : ________________
SUBSCRIBED AND SWORN TO before me this _______ day of _____________20____ at the
Philippine Embassy, Kuala Lumpur, Malaysia, affiant exhibiting to me his/her Philippine passport
no. _____________ issued in _____________________ on __________________
Doc. No. _________________
Series of _________________
Fee Paid _________________
O.R. No. _________________