Переклад, заява про відсутність одруження



State emblem


To the competent authorities

from —-

born in the year

place of residence — (passport – -, issued on —- by department of the Ministry of Internal Affairs of Ukraine in – –)

identification #


I, citizen of Ukraine, —, being in my right mind, clear memory, acting voluntary and understanding meaning of my actions without any physical or moral constraint, hereby certify that I am not officially or virtually married, and I was not officially or virtually married neither on the territory of Ukraine nor outside Ukraine.

I have completely read the text of this statement. The content of the statement is clear to me and corresponds to my will.



September —

SIGNATURE:             Signature —-.



—-, town of —, —, Ukraine

I, —, private notary of the — municipal notarial district in —- oblast, certify the authenticity of the signature of the citizen —. (place of residence —-) who personally came to me and is known to me as a person, stated in this document, signed the document in my presence and properly confirmed the drawing up of this document.

Registry # —-

Payment received in accordance with the asset 31 of the Law of Ukraine “About Notary activities”

Private notary: Signature            —

Round official seal

Private notary


— # —


Attention! This blank has a multilevel falsification protection.

Ministry of Justice of Ukraine