K. P.U. 2/1984
KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983
BORANG 19
BORANG 19
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
PERMOHONAN PERAKUAN KEMATIAN
(Seksyen 45)
Pendaftar,
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PERMOHONAN
1. Saya ..........................................................................................................................................
2. No. Kad Pengenalan ...................................................................................................................
3. Alamat .......................................................................................................................................
yang telah bernikah dengan -
4. Nama .........................................................................................................................................
5. No. Kad Pengenalan ...................................................................................................................
6. Alamat .......................................................................................................................................
7. Bil. Sijil Nikah ................................................................. Tarikh .................................................
8. Memohon satu Perakuan Kematian di atas suami/isteri saya -
......................................................................................................................................................
9. Bersama ini disertakan Ikrar dan salinan Sijil Pernikahan itu.
Bertarikh ......................................... 19 ............
Bersamaan ...................................... 14 ............
..............................................................
Tandatangan Pemohon / Cap Ibu Jari
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