BORANG 11 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

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

BORANG 11

BORANG 11
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
PERMOHONAN UNTUK MENDAFTAR PERNIKAHAN
(Seksyen 25)

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

1. Saya .........................................................................................................................................
2. No. Kad Pengenalan ...................................................................................................................
3. Alamat .......................................................................................................................................
yang telah dinikah dengan -
4. Nama ........................................................................................................................................
5. No. Kad Pengenalan ...................................................................................................................
6. Alamat ......................................................................................................................................
7. Pada ................................................. di ...................................................................................
memohon untuk pendaftaran pernikahan itu.
8. Bersama-sama ini disertakan Sijil Nikah yang diakui sah.
9. Bersama-sama ini disertakan bayaran yang dikehendaki.

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

.................................................................
Tandatangan Pemohon / Cap Ibu Jari