I, [Full Name as in passport] of the City of __________, in the Province of ________ DO SOLEMNLY AND SINCERELY DECLARE THAT:

1. I am [full name as in passport], born as [name as it appears in Birth Certificate] on [date of birth] in [place of birth].
2. I am a Canadian citizen with passport No. _______ who resides at [full address].
3. I intend to marry [full name as in passport] in the [Hotel Name] in [City], Dominican Republic during the week of [week of marriage].
4. I am single and have never been married before [If divorced, please put: I am divorced as per divorce certificate No. _______ as of {date of divorce}. During my previous marriage I was known as (name as appears on divorce certificate)________]. To the best of my knowledge and belief there is no legal impediment or other lawful cause to prevent me from getting married.
5. I am currently employed as a [occupation].
6. The names of my parents are _______________, Mother and ________________, Father.

AND, I make this Solemn Declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.