M0637WB01032018001

Karukutty Grama Panchayat

FORM No. 1
[See Rule 9(1)]
MEMORANDUM FOR REGISTRATION OF MARRIAGE

1. Date of Marriage : 22/10/2017

2. Place of Marriage : Local Area Village Taluk District

(Specify hall,
mandapam etc.)
St.George Church,Calvary Munnoorppilly Karukutty Aluva Ernakulam

3. Details of Parties to the Marriage (as on the date of marriage)

Details Husband Wife
(a) Name in full RAJU VARGHESE PAVITHA GEORGE
(in Capital Letters)
(b) Nationality Indian Indian
(c) Age and date of birth 28, 15/12/1988 25, 05/02/1992
(Sufficient proof such as S.S.L.C
Book, Passport, School Admission
Register or other records issued
by the Government showing the
date of birth shall be produced)
(ca) Occupation ENGINEER ACCOUNTANT
(d) Permanent Address s/o C D VARGEHSE, Chittinappilly House, d/o K A GEROGE, KACHAPPILLY HOUSE,
MUNNURPPILLY, MOOKANOOR, KURUMASSERY, Kurumassery, Ernakulam,
Ezhattumugham , Ernakulam, Kerala - 683577 Kerala - 683579

(e) Present Address Chittinappilly House, MUNNURPPILLY, d/o , KACHAPPILLY HOUSE,

MOOKANOOR, Ezhattumugham , Ernakulam, KURUMASSERY, Kurumassery, Ernakulam,
Kerala - 683577 Kerala - 683579

(f) Previous marital Status Unmarried Unmarried

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 M0637WB01032018001
Details Husband Wife
(g) Whether any spouse is NIL NIL
living (If yes, number of spouse
living)
(h) Signature with date
(i) Name of father or guardian C D VARGHESE (Father) K A GEORGE (Father)
and the relationship
(j) Age 61 60
(k) Address Chittinappilly House, KACHAPPILLY HOUSE,
MUNNURPPILLY, MOOKANOOR, KURUMASSERY, Kurumassery,
Ezhattumugham , Ernakulam, Kerala - Ernakulam, Kerala - 683579
683577
(l) Signature with date (If he is
a consenting party )
(m) Name of mother LISY VARGHESE RANI GEORGE
(n) Age 56 53
(0) Address Chittinappilly House, KACHAPPILLY HOUSE,
MUNNURPPILLY, MOOKANOOR, KURUMASSERY, Kurumassery,
Ezhattumugham , Ernakulam, Kerala - Ernakulam, Kerala - 683579
683577
(p) Signature with date (If she is
a consenting party )

4. Witness of solemnization of marriage :

1. (a) Name : RUPAN C VARGHESE
(b) Address : d/o C D VARGHESE, Chittinappilly House, MUNNURPPILLY, MOOKANOOR,
Ezhattumugham , Ernakulam, Kerala - 683577
(c) Signature with date :
2. (a) Name : ASHITHA GEORGE
(b) Address : d/o K A GEORGE, KACHAPPILLY HOUSE, KURUMASSERY, Kurumassery,
Ernakulam, Kerala - 683579
(c) Signature with date :
5. Details of records of marriage required under rule 9/rule 10, if any:
Document Name Document No Issue Date Issued By

Declaration of the Parties

We RAJU VARGHESE & PAVITHA GEORGE do hereby declare that the details shown
above are true to the best of our Knowledge and belief. Signature of the Parties :
Place : 1. Husband
Date : 2. Wife
For office use
Received by post / in Person on................................................................ Local Registrar

Registered in the Register of Marriages ( Common) on.....................................as Registration No....................................

Local Registrar

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