Schedule III

(Sec. 14 of the Act) NAME OF COURT DIVORCE CERTIFICATE NO. ____ OF _______ This is to certify that Smt. ___________________ d/o __________________________ (Name of father) or (name of mother) of _______________________________ (Name of village) and Shri ___________________________ (Name of ex-husband) s/o___________________________ of ______________________ who were married on _________________________ were divorce from each other by way of ___________________ under ______________________________________ with effect from ____________________________ due to _____________________. Hence their marriage stands dissolved. Name and Signature of Issuing Authority with Seal • 12 -Ex-570/2014