K. P.U. 2/1984
KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983
AM - BORANG 4
BORANG 4
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
IKRAR
Bahawasanya saya ....................................................... No. K /P ...................................................
beralamat .......................................................................................................................................
dengan sesungguhnya dan sucihati mengaku bahawa saya adalah isteri / suami kepada ......................
mengikut Sijil Pernikahan Bil.................................... dan membuat permohonan ................................
Dengan ini saya menyatakan bahawa :
(a) .................................................................................................................................................
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(b)..................................................................................................................................................
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(c) ..................................................................................................................................................
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(d) .................................................................................................................................................
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Diperbuat dan dengan sebenarnya diakui oleh yang tersebut namanya diatas
.............................................................
di ..........................................................
Negeri ..................................................
pada ........................................19 ......... |  | ..............................................................
Tandatangan Pemohon |
Di hadapan saya,
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Pendaftar / Kadi
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