1. Saya, ............................................................................................ No. Kad Pengenalan/Passport ....................................Tarikh lahir ............................................ Alamat ................................................................................... telah berkahwin dengan:
Nama ........................................................................................... No. Kad Pengenalan/Passport ...........................................
Tarikh lahir ............................................ Alamat ......................................................................................................................pada ............................. di alamat ..................................................................................................................................
2. Saya dengan ini memohon untuk didaftarkan perkahwinan saya dan disertakan bersama-sama ini satu salinan sijil perkahwinan saya yang diakui sah dan/atau keterangan yang berikut (jika ada)
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