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PEMERINTAH KABUPATEN PEMALANG

KECAMATAN RANDUDONGKAL
DESA RANDUDONGKAL
DATA DAN ARSIP SURAT BAWAH NIKAH
No

Lapor Hari

Tanggal

Bulan

Tahun

Akan menumpang nikah di Desa ................................................................... RT ...... RW ...........


Kecamatan ......................................................... Kab .............................. Prov ..........................
I.

II.

Calon Suami
1. Nama Lengkap dan alias
2. Bin
3. Tempat & Tgl Lahir
4. Warganegara
5. Agama
6. Pekerjaan
7. Tempat Tinggal
8. Nama Ibu
9. Status

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Calon Istri
1. Nama Lengkap dan alias
2. Bin
3. Tempat & Tgl Lahir
4. Warganegara
5. Agama
6. Pekerjaan
7. Tempat Tinggal
8. Nama Ibu
9. Status

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DATA DAN ARSIP SURAT BAWAH NIKAH


No

Lapor Hari

Tanggal

Bulan

Tahun

Akan menumpang nikah di Desa ................................................................... RT ...... RW ...........


Kecamatan ......................................................... Kab .............................. Prov ..........................
I.

II.

Calon Suami
1. Nama Lengkap dan alias
2. Bin
3. Tempat & Tgl Lahir
4. Warganegara
5. Agama
6. Pekerjaan
7. Tempat Tinggal
8. Nama Ibu
9. Status

:
:
:
:
:
:
:
:
:

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Calon Istri
1. Nama Lengkap dan alias
2. Bin
3. Tempat & Tgl Lahir
4. Warganegara
5. Agama
6. Pekerjaan
7. Tempat Tinggal
8. Nama Ibu
9. Status

:
:
:
:
:
:
:
:
:

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Pembatu Pegawai Pencatat Nikah (P3N)
Randudongkal RT 01-19 & 63 (Kemiri Sewu)
(Muhammad Bilalludin)

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