CERTIFICAT DE CELIBAT

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					                                CERTIFICAT DE CELIBAT


Before me, « name of the lawyer », « title », duly commissioned and qualified,
personally comes :

“first, middle, last name”

who, being duly sworn, deposes and certifies that my client said the following :

“I, first, middle, last name at birth”

was born on “date” in “city of birth, state, country”

My father’s full name is : “first, middle, last name”

My mother’s full maiden name is : “first, middle, maiden name”

Passport number : “number” issued on “date, month, year” at “city and country where
passport was issued”

I have never been married or I have been married and divorced of (name of the ex-
spouse) by the Superior Court of “city, state, country where spouse was divorced”.

Subscribed and sworn to before me on (date)

“Name of the lawyer”

				
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