On line copy marriage certificate application form

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	On line copy marriage certificate application form

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On line copy marriage certificate application form

Please complete the form below.

If you have any queries please contact.

Superintendent Registrar
Derby Register Office
Royal Oak House
Market Place
Derby
DE1 3AR

Tel: 01332 256526/ 256535/36

Fax: 01332 256525

Minicom: 01332 256666

Email: registeroffice@derby.gov.uk

For a printable version of this form please go to the copy certificates page.

You should only use this form if the event concerned occurred within Derby City or South Derbyshire Registration District.

Marriage Certificate Application Form

Fields marked with '*' are required fields.

Title	*
Last name	*
First name	*
House No. or name	*
Address	*
Postcode	*
Relationship to person named below	*
Reason for applying for certificate
Bridegroom's last name on wedding day	*
Bridegroom's first name on wedding day	*
Bride's last name on wedding day	*
Bride's first name on wedding day	*
Date of marriage	*
Place of marriage	*
Bridegroom's last name before wedding day	*
Bridegroom's first name before wedding day	*
Bride's last name before wedding day	*
Bride's first name before wedding day	*

Data Protection: This form is not secure. Please don't include any confidential or sensitive information on it. We will treat any other personal information you provide in confidence and under the Data Protection Act 1998. We will hold it and only use it for a legal reason or for the purpose it is given. We will only share information when we have your consent or we need to ask another department or partner to respond to a specific comment or request you have made.

We will keep a record of the sender's Internet Protocol address (which is unique to the sender's computer), the date we received the form, and the content for back-up and archive purposes. We will also use this record to identify senders of any malicious content under the Protection from Harassment Act 1997. We will keep this record for a maximum of three months.

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