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Declaration for the Reapplication for Marriage Certificate
2011/04/01     Source:

I hereby declare for the reapplication for__________   (Marriage Certificate / Divorce Certificate) that:

Name of Applicant: ________________Gender:____Nationality:_______
Date of Birth:________ (Date/Month/Year)  Nation:______
Occupation:______
Degree of Education:_______ ID Card Number:_______________________
Registered Permanent Residence:_____________________________________

Name of Spouse: ________________Gender:____Nationality:_______
Date of Birth:________ (Date/Month/Year)  Nation:______Occupation:______
Degree of Education:_______ ID Card Number:_______________________
Registered Permanent Residence:_____________________________________

My spouse and I got (marriage/divorce) registration at the marriage registration office in _______ (location) on      (Date/Month/Year) and have maintained the status to this day. Due to the _________ (loss/damage) of the certificate, I now reapply for the issuance of the certificate.

All the above declarations are true, and I am willing to undertake all corresponding legal responsibilities if there’s any falsehood.

Declarant:____________      Supervisor:____________
____________ (Date/Month/Year)   ____________ (Date/Month/Year)

(Note: Signing of the declarant shall be executed under the supervision of the supervisor.)

申请补领婚姻登记证声明书

本人申请补领__________(结婚证/离婚证),谨此声明:

本人姓名:________________性别:____国籍:________
出生日期:____年___月___日  民族________职业:________
文化程度:_______ 身份证件号:________________________
常住户口所在地:________________________________

对方姓名:________________性别:____国籍:________
出生日期:____年___月___日  民族________职业:________
文化程度:_______ 身份证件号:________________________
常住户口所在地:________________________________

本人与对方于____年___月___日在__________________婚姻登记处登记_______ (结婚/离婚) 。本人与对方至今仍维持该状况,现因婚姻登记证_______ (遗失/损毁) ,申请补领。

本人上述声明完全真实,如有虚假,愿承担法律责任。

声明人:____________    监誓人:____________
_____年____月____日   _____年____月____日 

(注:声明人签名须在监誓人面前完成)

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