Transcription of PHILIPPINE CONSULATE GENERAL, CHICAGO
1 (REVISED MARCH 2013) DATE OF REPORT ID # 1. LAST NAME(WIFE'S MAIDEN LAST NAME) 2. FIRST NAME 3. MIDDLE NAME 4. DATE OF birth (day-month-year) 5. AGE (AT THE TIME OF MARRIAGE) PLACE OF birth 7. CITIZENSHIP 8. ADDRESS AND TEL. NO. 9. CIVIL STATUS (CHECK ONE)( ) SINGLE( ) DIVORCED ( ) WIDOW/ WIDOWER( ) SINGLE ( ) DIVORCED ( ) WIDOW/ WIDOWER 10. RELIGION 11. OCCUPATION 12. FATHER'S FULL NAME 13. CITIZENSHIP 14. MOTHER'S FULL NAME 15. CITIZENSHIP 16. NAME OF WITNESS 1 17. RESIDENCE 18. NAME OF WITNESS 2 19. RESIDENCE 20. DATE OF MARRIAGE 21. PLACE OF MARRIAGE 22. NAME OF SOLEMNIZING/ OFFICIATING OFFICER 23. TITLE OF SOLEMNIZING/ OFFICIATING OFFICER ( ) MARRIAGE CERTIFICATE ( ) COPIES OF PASSPORTS OF CONTRACTING PARTIES Date : Service No.
2 : No. : Fee Paid : $ OF THE PHILIPPINES we/ I hereby set our hands this _____ day of _____ at _____. Signature of Husband : _____Signature of Wife : _____HUSBAND'S PARENTSWIFE'S PARENTS We/ I solemnly swear under penalty of law that the statements made on this report are true and correct, and the attached supporting documents are authentic; and PARTICULARS OF CONTRACTING PARTIESHUSBANDWIFEDETAILS OF ASCENDANTSFORM PRESCRIBED BY FSC 75-94DO NOT LEAVE ANY SPACES BLANK. INDICATE N/A IF NOT APPLICABLE. PHILIPPINE CONSULATE GENERAL, CHICAGO REPUBLIC OF THE PHILIPPINES DEPARTMENT OF FOREIGN AFFAIRS REPORT OF MARRIAGEOF A PHILIPPINE CITIZEN ABROADEMBASSY/ CONSULATE OF THE REPUBLIC OF THE PHILIPPINES The marriage was today registered with the Embassy/ CONSULATE under No.
3 _____ of the Civil Registry Book. This report has been executed in a quadruplicate, copy furnished the contracting parties, copy transmitted to the Department of Foreign Affairs (DFA) in Manila, copy transmitted to the Civil Registrar through the DFA, and copy places in the files of this Embassy/ CONSULATE together with the following supporting documents:REQUIREMENTS TO REPORT MARRIAGE a) Accomplish Report of Marriage form. - two (2) originals and three (3) photocopies b) Original/certified true copy and four (4) photocopies of registered marriage certificate. c) Four (4) photocopies of birth Certificate d) Four (4) photocopies of passports of the contracting parties e) For widowed applicant or spouse four (4) photocopies of the deceased spouse's Death Certificate f) For annulled/divorced marriages - four (4) photocopies of annotated Marriage Contract or Certificate of registration and certified true copy of Court Order g) For applicants with divorced spouse - four (4) photocopies of divorce decree (If the spouse is former Filipino citizen, please submit four photocopies of naturalization paper as proof that the spouse was a US citizen at the time of divorce) h)
4 Notarized Affidavit of delayed registration (marriage must be reported to the CONSULATE within 12 months after the solemnization of marriage) two (2) originals and two (2) photocopies i) Fee : $ in money order or cashier s check payable to the PHILIPPINE CONSULATE General j) Pre-paid return envelope Only Marriage Certificates from the following states are accepted by the CONSULATE : Arkansas Mississippi Illinois Missouri Indiana Nebraska Iowa North Dakota Kansas Ohio Louisiana Oklahoma Michigan South Dakota Minnesota Wisconsin
5 AFFIDAVIT FOR delayed registration OF birth MARRIAGE DEATH (To be accomplished by either the father/mother/guardian or the person himself if 18 years old and above) I, _____ of legal age, single/married and with residence and postal address at _____. After having duly sworn to in accordance with law, do hereby depose and say: 1. That I am the applicant for the delayed registration of birth /marriage/death of _____. 2. That I/he/she was born on _____ in _____. 3. That I/he/she am/is a citizen of the Philippines. 4. That the reason for the delay in registering the birth /marriage/death was due to _____. _____ Signature SUBSCRIBE AND SWORN to before me this __ day of _____ 201_.
6 _____ Notary Public
