I, E.F.hereby certify that on the day
Of 200-- A.B.and C.D.* { * Herein give particulars of the parties}
before me and that each of them, in my presence and in the presence of three witnesses who have signed hereunder, made the declarations of required by section 11 and that a marriage under this Act was the solemnized between them in my presence
(S.d) E.F.,
Marriage Officer for
(S.d) A.B.,
Bridegroom
(S.d) C.D.,
Bride
(S.d) G.H., ]
]
(S.d) I.J. ] -------- Three witnesses
]
(S.d) K.L ].
Dated the day of 200--
