Form D

GOVERNMENT OF MAHARASHTRA

HEALTH DEPARTMENT

MUNICIPAL CORPORATION OF GREATER MUMBAI

MEMORANDUM OF MARRIAGE
Marriage Details Registration No. : 0050129499

Date of Marriage: 20.01.2016 Ward : D

Personal Law according to which the marriage between the parties was solemnizes :
MAHARASHTRA REGULATION OF MARRIAGE BUREAUS AND REGISTRATION OF MARRIAGES ACT 1998

Place of Marriage(with full particulars) : Shiv Vishnu Mandir, Hall, Sector 9-A, Near
Vashi Bus Depo, Vashi, NAVI MUMBAI, 400703, Maharashtra, India.

Husband Details

Name of the Husband (Full name beginning with surname) : Mr. PANDEY SHYAMKUMAR SURESH

Other names (if any) by which the husband is known :

i. By Birth : Hindu

ii. By adoption (if any) :

Date of Birth & Age as on the date of the solemnization of marriage(Years): 01.05.1987
& 28

Status at the time of marriage (Unmarried/Widower/Divorced): Unmarried

Full address at time of Marriage : 3, LAXMAN BUILDING, DR BHALERAO MARG GIRGAUM,

MUMBAI, 400004, Maharashtra, India.
Email :print.sc111@gmail.com.

Occupation along with office address:Others

Wife Details

Name of the Wife(Maiden Name) (Full name beginning with surname) : Ms. DUBEY HEMLATA
KANAHYALAL

Other names (if any) by which the Wife is known :

i. By Birth : Hindu

ii. By adoption (if any) :

Date Of Birth & Age as on the date of the solemnization of marriage(Years): 19.07.1990
& 25

Status at the time of marriage (Unmarried/Widower/Divorced): Unmarried

Residential address before or at time of Marriage : JN4 14-4 BLUE HEVEN, SECTOR 10,
VASHI, NAVI MUMBAI, 400703, Maharashtra, India.

Occupation along with office address:Others

Witness 1 Details

Name of Witness 1: Mr. SURESHKUMAR GIRIJASHANKAR PANDEY

Relation (if any) with the married couple: FATHER

Address : LAXMAN BLDG GR FLR, ROOM NO 3 KELEWADI GIRGAON, DR BHALERAO MARG, MUMBAI,
400004, Maharashtra, India.

Occupation along with office address:Others

Witness 2 Details

Name of Witness 2 : Mrs. PUSHPA SURESH PANDEY

Relation (if any) with the married couple: MOTHER

Address : LAXMAN BLDG GR FLR, ROOM NO 3 KELEWADI GIRGAON, DR BHALERAO MARG, MUMBAI,
400004, Maharashtra, India.

Occupation along with office address:Others

Witness 3 Details

Name of Witness 3: Mr. GIRIJASHANKAR GOKUL PANDEY

Relation (if any) with the married couple: GRANDFATHER

Address : LAXMAN BLDG GR FLR, ROOM NO 3 KELEWADI GIRGAON, DR BHALERAO MARG, MUMBAI,
400004, Maharashtra, India.

Occupation along with office address:Others

Priest Details

Name of Priest: Mr. HARISH MANOJKUMAR DUBEY

Religion : Hindu

Age (Years): 56

Address : SHIV MANDIR, Juhu Nagar, Plot No. 8 - 9, Vashi,, NAVI MUMBAI,, 400703,
Maharashtra, India.

Priest's Sign: ____________________________

Checklist Details

1. Memorandum of marriage Form D details are correctly entered :Yes

2. Proof of age(Attested photocopy of any one of the following)

a. For Bride,18 yrs(completed)
1. School / College leaving certificate : No
2. Birth certificate : No
3. Passport : Yes
4. Domicile : No
5. SSC / HSC certificate : No

b.For Bridegroom,21 yrs (completed)

1. School / College leaving certificate : No
2. Birth certificate : No
3. Passport : Yes
4. Domicile : No
5. SSC / HSC certificate : No

3. Whether residing within the jurisdiction of marriage registrar ?

a. Bride : No
b. Bridegroom : Yes

4. Proof of residence (Attested photocopy of any one of the following)

a. For Bride
1. Ration card :No
2. Election card :No
3. Telephone bill(in the name of person) :No
4. Electricity bill(in the name of person) :No
5. Passport :Yes
6. Adhaar card :No

b. For Bridegroom
1. Ration card : No
2. Election card : No
3. Telephone bill(in the name of person) : No
4. Electricity bill(in the name of person) :No
5. Passport :Yes
6. Adhaar card :No

5 Address proof of Witnesses

a. For Witness 1
1. Ration card :No
2. Election card :No
3. Telephone bill (in the name of person) :No
4. Electricity bill(in the name of person) :No
5. Passport :No
6. Adhaar card :Yes

b. For Witness 2
1. Ration card :No
2. Election card :No
3. Telephone bill(in the name of person) :No
4. Electricity bill(in the name of person) :No
5. Passport :No
6. Adhaar card :Yes
 c. For Witness 3
1. Ration card :No
2. Election card :No
3. Telephone bill(in the name of person) :No
4. Electricity bill(in the name of person) :No
5. Passport :No
6. Adhaar card :Yes

6. Copy of wedding card :Yes

Self declaration if wedding card not produced :

7. Name and sign of the priest :Yes

8. Passport size photographs of Bride,

Bridegroom :Yes

9. Divorcee : :No
Court Decree
a. Divorce certificate (Attested Copy) :
b. Court Order (Attested Copy) :

10. Widower :No

a. Death Certificate :

11. Nikahnama :No

In case both bride and groom are of Muslim religion Nikahnama to be produced (If
Nikahnama is issued in Urdu should be translated in English by the party)

12. If Husband Wife are of different religion then as per the act either Husband or
Wife have to convert his/her religion to match the religion of another to the said
marriage prior to the date of marriage. In this case if one of the parties is
converting himself/herself from his/her own religion (by birth) and adopting religion
of the second party then they should produce following documents (if applicable):
No

a. Affidavit of party on the stamp paper of Rs.100/- :

b. Self affidavit of priest/kazi on the stamp paper of Rs.100/- :
c. Joint declaration on stamp paper of Rs.100/- :
 1. Husband Photograph 2. Wife Photograph

1. Paste Photo of 2. Paste Photo of

Husband here and Wife here and
Sign within Sign within
box below box below

3. Witness 1 Photograph 4.Witness 2 Photograph 5.Witness 3 Photograph

3. Paste Photo of 4. Paste Photo of 5. Paste Photo of

Witness1 here Witness2 here Witness 3 here
and Sign and Sign and Sign
within box below within box below within box below

Note:
(A) Photos of husband, wife & 3- witnesses must be pasted in the respective box on
the application form.

B) Husband, wife & 3- witnesses are required to do signature on the application forms
only in front of Sub-Registrar.

C) Husband, wife & 3- witnesses all must be present in person in front of

Sub-Registrar on the date of appointment.

D) All required documents original & one set of gazette attested photo copy and the
original application form & receipt must be produced to the Sub-Registrar on the date
of appointment and photo copy set should be submitted to the Sub-Registrar office.

E)Please check your email id Email :print.sc111@gmail.com. to view the receipts or

application form or marriage registration certificate.

F)While making final payment to get marriage certificate, applicant must log on to
URL : http://portal.mcgm.gov.in and enter marriage registration no in payment receipt
tab located under path : Citizen Services --> Health Services --> Marriage
Registration.

G)The applicant is hereby requested to recheck the PDF printout of the form for
spelling mistakes & other corrections. If any corrections are required it should be
brought to the notice of the Registrar at the time of appointment along with document
proof wherever necessary.

H)Applicant should note that once the application if approved by the Registrar and
the Marriage Certificate is generated, after that no corrections what so ever will be
made on the Marriage Certificate.