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SUAMI
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ISTRI
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WALI
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NO
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SUAMI
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ISTRI
: ......................................
WALI
: ......................................
IJAB / PELAKSANAAN
IJAB / PELAKSANAAN
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JAM
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P3N
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SAKSI
: 1. ..................................
2. ..................................
P3N
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: ......................................
DAFTAR PEMERIKSAAN
DAFTAR PEMERIKSAAN
NO
: ......................................
HARI/TGL
: ......................................
CALON
: ......................................
SUAMI
: ......................................
ISTRI
: ......................................
WALI
: ......................................
NO
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HARI/TGL
: ......................................
CALON
: ......................................
SUAMI
: ......................................
ISTRI
: ......................................
WALI
: ......................................
IJAB / PELAKSANAAN
IJAB / PELAKSANAAN
HARI
: ......................................
HARI
: ......................................
TANGGAL
: ......................................
TANGGAL
: ......................................
JAM
: ......................................
JAM
: ......................................
TEMPAT
: ......................................
TEMPAT
: ......................................
SAKSI
: 1. ..................................
SAKSI
: 1. ..................................
2. ..................................
P3N
: ......................................
DAFTAR PEMERIKSAAN
2. ..................................
P3N
: ......................................
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