To,
Marriage Officer for the .........................................................................District.
We hereby give you notice that a marriage under the Special Marriage Act, 1954 (SMA 1954), is intended to be solemnized between us within three calendar months from the date hereof.
| Name | Condition | Occupation | Age | Dwelling place | Permanent place dwelling if present dwelling place not permanent | Length of residence |
|---|---|---|---|---|---|---|
| A.B. | UnmarriedWidowerDivorcee | |||||
| C.D. | UnmarriedWidowerDivorcee |
Witness our hands this ....................................day of...........................................20......
(Sd.) A.B.,
(Sd.) C.D.,