Pg. P.U. 5/2000
MARRIAGE, DIVORCE AND RUJU' (STATE OF PENANG)
RULES 2000



FIRST SCHEDULE (Form 18)
FORM 18

(Rule 17)

APPLICATION FOR CERTIFIED TRUE COPY OF ENTRY IN
REGISTER OF MARRIAGE/DIVORCE/RUJU'

MARRIAGE
DIVORCE
RUJU’
1.Full name of Husband:



I/C No.:



(New)


(Old)



--



Address: (When Solemnised).......................................................................

2.Full Name of Wife:



I/C No.:



(New)


(Old)



--



Address: (When Solemnised).......................................................................

3.Date of Solemnisation:

4.District:
(Solemnisation)		Bandaraya[]B.Pulau[]N.Tebal[]

B.Mertajam[]K.Batas[]B'worth[]
5.Name of Applicant:
I/C No.:

6.Relationship With Applicant:.............................................................
7.Mail Address:.............................................................
Tel. No. ..............................................
8.Grounds of Application:.............................................................
9.Date:


............................................
Signature of Applicant


FOR OFFICE USE

Application No/Marriage Certificate No.:

Amount paid: RM..................................... Receipt No. ..................................

Remarks: ................................................................
Date:



.............................................
Chief Registrar,
Marriage, Divorce and Ruju',
Penang



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