THE FIFTH SCHEDULE

(See section 16)

CERTIFICATE OF MARRIAGE CELEBRATED IN OTHER FORMS


I, E.F., hereby certify that A.B.and C.D.* appeared before me {*Here in give particulars of the parties} this day 19 and that each of them, in my presence have declared that a ceremony of marriage has been performed between them and that they have been living together as husband and wife wince the time of their marriage, and that in accordance with their desire to have their marriage registered under this Act the said marriage has, this
Day of 19 been registered under this Act, having effect as from

(S.d) E.F.
Marriage Officer for
(S.d) A.B.
Husband
(S.d) C.D.
Wife

(S.d) G.H.
(S.d) I.J. Three witnesses.
(S.d) K.L.

Dated the day of 19.