Government of Tamil Nadu Registration Department Special Marriage Declaration The Third Schedule (See Section 11 of the Special Marriage Act) Declaration To Be Made By The Bridegroom I.A, B hereby declare as follows: - 1. I am at the present time unmarried (or a widower or a divorcee, as the case may be ) 2. I have completed ---------------years of age. 3. I am not related to C.D.(the bride) within the degrees of prohibited relationship. 4. I am aware that, if any statement in this declaration is false, and if in making such statement I either know or believe it to be false or do not believe it to be true, I am liable to imprisonment and also to fine. (Sd) A.B. (the bridegroom) DECLARATION TO BE MADE BY THE BRIDE I C.D., hereby declare as follows: - 5. I am at the present time unmarried(or a widower or a divorcee, as the case may be) 6. I have completed ---------------years of age. 7. I am not related to C.D.(the bridegroom) within the degrees of prohibited relationship . 8. I am aware that, if any statement in this declaration is false, and if in making such statement, I either know or believe it to be false or do not believe it to be true, I am liable to imprisonment and also to fine. (Sd) C.D (the bride) Signed in our presence by the above- named A.B. and C.D. So far as we are aware there is no lawful impediment to the marriage. (Sd) G.H.| (Sd) I.J | Three witnesses (Sd) K.L. | Countersigned E.F. Marriage Officer. Date the -------------------------day of--------------200----.
