| Saint Lucia, West Indies. |
District Registrar's Certificate, under
Foreign Marriages Act. |
| I ............................................ Registrar for the District of ....................... hereby certify that on the ................... day of ................... 20 .........., (1) ..................... duly gave notice to me of h ...................... (2) intended marriage to (1) ...................... and that all the requirements of His Britannic Majesty's “Foreign Marriages Order in Council, 1913” in respect of residence and notice so far as the said (3) ........................ is concerned, have been complied with. No opposition to such intended marriage has been served upon me. |
| Certified by me the said ....................................... this ................................. day of ................................. 20 .......... . |
| ......................................................................... |
| Registrar of the District of |
| (1) State name, place of residence, condition or calling. |
| (2) His or her. |
| (3) Name of party who gave notice. |