BORANG 10 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

K. P.U. 2/1984
KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

BORANG 10

BORANG 10
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
PENDAFTARAN PERNIKAHAN LUAR NEGERI
(Seksyen 23)

Pendaftar,
.......................................................................
.......................................................................
.......................................................................

Dengan ini dimaklumkan bahawa permohonan untuk pendaftaran pernikahan* telah diluluskan dan butir-butirnya adalah seperti berikut untuk didaftarkan :

1. Nama lelaki ...............................................................................................................................
No. Kad Pengenalan ......................................................................................................................
Alamat ..........................................................................................................................................
2. Nama perempuan ......................................................................................................................
No. Kad Pengenalan .....................................................................................................................
Alamat .........................................................................................................................................
3. Anak dara, balu atau janda dsb ...................................................................................................

(sertakan keterangan)

.....................................................................................................................................................
4. Nama wali kad pengenalan dan alamat ........................................................................................
5. Apa nisbah wali dengan perempuan itu ........................................................................................
6. Jumlah maskahwin, tunai atau tangguh ........................................................................................
7. Lain-lain perbelanjaan, tunai atau tangguh .....................................................................................
8. Pemberian, jika ada ....................................................................................................................
9. Taalik, jika di lafaz ......................................................................................................................

(gunakan lampiran jika perlu)

10. Tempat pernikahan, tarikh dan masa ...........................................................................................
......................................................................................................................................................
11. Pegawai yang mengakad ...........................................................................................................

(sebutkan jawatan pegawai yang mengakad dsb.)

12. Nama saksi, No. Kad Pengenalan dan alamat :
(i) ..................................................................................................................................................
.....................................................................................................................................................
(ii) .................................................................................................................................................
.....................................................................................................................................................
(iii) ................................................................................................................................................
.....................................................................................................................................................

Bertarikh ............................................ 19 ...............
Bersamaan ......................................... 14 ...............

.................................................
Pendaftar/Kadi

* No. Pernikahan ....................................................