Example: Certificate of No Impediment

The United Republic of Tanzania RGM. 12

Application for Certificate of No Impediment

(This Form should be sent to Dar es Salaam or Zanzibar

(The Law of Marriage Act, 1971, Section 35)

  1. Full Name as shown on Passport
    Surname
    Other Names
  2. Age:
  3. Place of Birth:
  4. Nationality:
  5. Religion:
  6. Original address in Tanzania:
  7. Present occupation:
  8. Former occupation:
  9. Name of former employer:
  10. Address of former employer:
  11. Employed from (date):
  12. Father’s or mother’s name:
  13. Full name of intended wife/ husband:
  14. Nationality
  15. Address of intended wife/husband:
  16. If married before or not:
  17. If married under Customary law:
  18. Full particulars why certificate of no impediment should be given (Attach)
  19. I, (name) declare that the information given in this application is true and correct.
  20. Date
    Place

Signature of Applicant

 Made and subscribed this (Date) day of (Year), before me

(Signed)

(Notary Public/Commissioner for Oaths)