REPUBLIC OF THE PHILIPPINES NOT FOR SALE

FORM PRESCRIBED BY FSC 75-94

DEPARTMENT OF FOREIGN AFFAIRS (REVISED MARCH 2013)
REPORT OF MARRIAGE DATE OF REPORT
FOR FILIPINOS MARRIED ABROAD (day-month-year)
THIS FORM IS NOT FOR SALE. DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE.

Foreign Service Post: ID#

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/ ANNULLED WIDOW/WIDOWER SINGLE DIVORCED/ ANNULLED WIDOW/WIDOWER

10. RELIGION

11. OCCUPATION

DETAILS OF ASCENDANTS
HUSBAND'S PARENTS WIFE'S PARENTS
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

(day-month-year)

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

This marriage was today registered with the Embassy/ Consulate under No. _____________________________ of the Civil Registry Book. This report has been executed in
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 placed in the files of this Embassy/ Consulate together with the following supporting documents:

( ) MARRIAGE CERTIFICATE
( ) COPIES OF PASSPORTS OF CONTRACTING PARTIES
Date: __________________________
Service No.: _____________________
O.R. No.:________________________
Fee Paid: _______________________ SEAL REPUBLIC OF THE PHILIPPINES