PONDOK PESANTREN AL - QODIM DARUSSURUR XII

MAJLIS TALIM DAN DAWAH

Jl. Cagak No. 01 Rt.03 Rw.04 Lagadar Margaasih Kab. Bandung 40216
Telp. 081 322 565 537 - 082 116 240 533 - 085 221 074 280
DAFTAR NIKAH
Hari .......... Tgl ............ Tahun ......... M/Tgl....... Bulan ............
........... Tahun ..........H Jam
Calon suami
Calon Istri
1. Nama
: ................................................... .....................................
....................
2. Bin/Binti
: ................................................... .....................................
....................
3. Tgl.Lahir
: ................................................... .....................................
....................
4. Agama
: ................................................... ............................
.............................
5. Pekerjaan : ................................................... .....................................
....................
6. Alamat
: ...................................................
.........................................................
................................................... .....................................
....................
........................................................................................
....................
7. Status
: ..................................................
.........................................................
8. Pendidikan Terakhir : .........................................
.........................................................
Bapak Calon Suami
Istri

Bapak Calon

1. Nama
: .................................................. .....................................
....................
2. Bin
: .................................................. .....................................
....................
3. Tgl.Lahir
: .................................................. .....................................
....................
4. Agama
: .................................................. ............................
.............................
5. Pekerjaan : .................................................. .....................................
....................
6. Alamat
: .................................................. ............................
.............................
Ibu Calon Suami
Istri

Ibu Calon

1. Nama
: .................................................. .....................................
....................
2. Tgl.Lahir
: .................................................. .....................................
....................
3. Agama
: .................................................. ............................
.............................
4. Pekerjaan : ..................................................
.........................................................



PONDOK PESANTREN AL - QODIM DARUSSURUR XII
MAJLIS TALIM DAN DAWAH
Jl. Cagak No. 01 Rt.03 Rw.04 Lagadar Margaasih Kab. Bandung 40216
Telp. 081 322 565 537 - 082 116 240 533 - 085 221 074 280
DAFTAR NIKAH
Hari .......... Tgl ............ Tahun ......... M/Tgl....... Bulan ............
........... Tahun ..........H Jam
5. Alamat
: .................................................. ............................
.............................
Dengan Memakai Wali Nasab/Hakim
1. Nama
: .................................................. .....................................
...................
2. Bin
: .................................................. .....................................
...................
3. Tgl.Lahir
: .................................................. .....................................
...................
4. Agama
: ..................................................
.......................
.................................
5. Pekerjaan : .................................................. Tunai / Diutang
6. Alamat
: ..................................................
Saksi I
Saksi II
Suami
Istri
Wali

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Pengasuh Ponpes

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