The Form of a Licence for Marriage so to be granted as aforesaid to any Party or Parties, by the Superintendent Registrar of any District as aforesaid, shall be in the Form or to the Effect of the Licence set forth in Schedule (C.) to this Act annexed; and for every such Licence the Superintendent Registrar granting the same shall be entitled to have and receive of the Party requiring the same the Sum of One Pound Ten Shillings, over and above the Amount paid for the Stamps necessary on granting such Licence.