(DFA-OCA-CRD-06 / REV.01 / 24 APRIL 2018)

PHILIPPINE FOREIGN SERVICE POST: DATE OF REGISTRATION: REGISTRY NUMBER: HUSBAND'S LAST NAME: WIFE'S LAST NAME: HUSBAND'S FIRST NAME: WIFE'S FIRST NAME: HUSBAND'S MIDDLE NAME: WIFE'S MIDDLE NAME: HUSBAND'S DOB: WIFE'S DOB: HUSBAND'S POB: WIFE'S POB: POM: DOM: WITNESS 1: WITNESS 2: NAME OF OFFICIATING OR SOLEMNIZING AUTHORITY: TITLE: FATHER'S FULL NAME 1: FATHER'S FULL NAME 2: MOTHER'S MAIDEN NAME 1: MOTHER'S MAIDEN NAME 2: PLACE OF NOTARY: DATE OF NOTARY: REMARKS / ANNOTATIONS: DATE OF PAYMENT: DOC NO: SERVICE NO: OR NO: FEE PAID: BOOK NO: SERIES OF: HUSBAND'S CITIZENSHIP: WIFE'S CITIZENSHIP: HUSBAND'S DATE AND PLACE OF REGISTRATION: WIFE'S DATE AND PLACE OF REGISTRATION: HUSBAND'S RELIGION: WIFE'S RELIGION: HUSBAND'S FATHER CITIZENSHIP: WIFE'S FATHER CITIZENSHIP: HUSBAND'S MOTHER CITIZENSHIP: WIFE'S MOTHER CITIZENSHIP: POST: HUSBAND'S CIVIL STATUS: WIFE'S CIVIL STATUS: SIGNATURE OF HUSBAND: SIGNATURE OF WIFE: